32 M. Koopmanschap et al.
These studies have demonstrated the impor-
tance of considering productivity costs in eco-
nomic evaluations of provisions of (occupational)
health care, such as return to work programs. In
general, cost-effectiveness analyses are deter-
mined largely by the productivity costs and, thus,
their appropriate assessment in economic evalua-
tion is of paramount importance. However, the
comparability across cost of illness and cost-
effectiveness studies is hampered by substantial
differences in costs items considered, methods
used for measuring sickness absence and presen-
teeism, and actual valuation of, for example, a day
absent from work.
This chapter will present principles of eco-
nomic evaluation of disability, sickness absence,
and productivity loss at work. First, some basic
concepts and deﬁnitions are discussed in Sect. 3.2.
Section 3.3 further explores the relevance of ele-
ments of productivity loss in speciﬁc counties
and disease categories. Section 3.4 describes and
comments on the important methodological
debates regarding the valuation of productivity
costs, whereas Sect. 3.5 addresses the perspective
of the analysis. We conclude with a brief discus-
sion and research agenda in Sect. 3.6.
3.2 Some Basic Concepts
A central concept in this chapter is the term pro-
ductivity costs. In health economics in general
and especially in the ﬁeld of economic evaluation
of health care and occupational medicine, we
deﬁne productivity costs as “the costs associated
with production loss and replacement due to ill-
ness, disability and death of productive persons,
both paid and unpaid” (Brouwer et al. 1999).
Although the deﬁnition above refers to paid and
unpaid work, in practice, most research focuses
on productivity costs related to paid work.
Productivity costs can be substantial when ill-
ness and treatment affect the productivity of
workers. Productivity costs are present in the fol-
In case of unscheduled absence from work•
(due to health problems)
In case of reduced productivity at work: one•
might work with health problems that will
constrain and limit a worker to carry out his
regular activities and, this may lead to a lower
productivity (also called efﬁciency loss or
In case of permanent disability to work•
In case of death (before the age of retirement)•
Normal functioning at work, absenteeism, and
presenteeism can be interrelated. Brouwer et al.
(2005) showed (see Fig. 3.1) that presenteeism
often occurs before or after absenteeism, when
health problems do not completely inhibit work-
ers being productive at work. Presenteeism is
also relevant for return to work programs, when
partially recovered workers return to their work
place, as illustrated by Lötters et al. (2005).
Productivity costs are sometimes also called
indirect nonmedical costs, as these costs repre-
sent a more indirect economic consequence of
disease, which become manifest outside the
health care sector. (For comparison, hospital
treatment costs for a disease are a part of the so-
called direct medical costs.) However, for clarity
we prefer the term productivity costs.
In economic evaluation studies that analyze
the cost-effectiveness of occupational interven-
tions, several perspectives can be taken, i.e., the
societal perspective, governmental perspective,
ﬁrm perspective, or workers’ perspective
(Drummond et al. 2005; Tompa et al. 2008) (see
Chap. 23). For economic evaluation studies of
health care programs Drummond et al. (2005)
strongly advise to use the societal perspective, as
the costs and beneﬁts of health (occupational)
care programs often affect several actors in soci-
ety (differently) and are often ﬁnanced by public
All perspectives have to deal with prospects
and consequences. By now some workplace-
based intervention studies undertake economic
analyses (Tompa et al. 2008). Most of these eco-
nomic evaluations of workplace interventions
were conducted from the perspective of the ﬁrm/
company (Tompa et al. 2008). This is under-
standable, as the employer is an important stake-
holder, who in the case of sick workers is
primarily confronted with productivity losses
and costs to maintain the production. However,
as productivity costs might depend on eligibility
criteria of social security beneﬁts and allocation
333 Work Absenteeism and Productivity Loss at Work
of these costs to different stakeholders, and are
also inﬂuenced by access and quality of occupa-
tional health and health care (that may fall on
other actors than the employer), it is in general
advisable to take the societal perspective.
However, the cost of productivity losses as an
argument/motivator to change policies and
implement occupational health interventions
makes the individual and company perspectives
also important because these stakeholders have
different interests or do not have the same
beneﬁts. The situation may even be more com-
plex in North American and Australian jurisdic-
tions, where responsibility for costs depends on
work-relatedness of the illness and work acci-
dents and occupational disorders are being sepa-
rately dealt with by Workers Compensation
Boards (WCB). In these jurisdictions, the
employer may be charged back for disability fol-
lowing experience rating, depending on the num-
ber and severity of previous work disability
cases. Also, a worker having a very reduced pro-
ductivity level due to an occupational accident or
disorder may be less costly “at work” than absent
as his/her salary is not augmented by supplemen-
tary charges from the WCB: presenteeism with
zero productivity is less deleterious from the
perspective of the employer than absenteeism
and is much less costly from the perspective of
the WCB (see Chaps. 12 and 10).
3.3 The Relevance of Productivity
Losses and Costs
During the last decades abundant material has
been published, demonstrating the large amount
of productivity losses and associated costs related
to illness. We cannot discuss all evidence, but we
will summarize the main highlights, illustrated
by results of recent research.
In an extensive study by the OECD it appears that
worldwide the absence from work in general varies
between 1 and 7% of total working time (OECD
2010). The Nordic European countries show the
highest absence rates, e.g., Norway almost 7%,
Sweden 5%, and Finland 4–5% belong to the top
three (OECD 2010) (see Chap. 1).
Fig. 3.1 An illustration of the possible relationship
between productivity and QOL. Q1
represents the level of
health above which a person is fully productive and below
which one experiences presenteeism (i.e., a person is pres-
ent at work but with reduced productivity); Q2
the level of health below which a person will be absent
34 M. Koopmanschap et al.
Absenteeism as a result of health problems is
clearly most prominent for musculoskeletal dis-
ease (mainly back pain) and mental disorders
(especially depression) (Goetzel et al. 2004). For
example, McDonald et al. (2011) reported that
among US workers with musculoskeletal pain
7% lost workdays due to absenteeism. In the
Netherlands, 46% workers with low back pain
being treated by a physiotherapist were absent at
least one day from work during the previous 6
weeks (Hoeijenbos et al. 2005). From patients
with subthreshold depression, Smit et al. (2006)
estimated the mean annual costs of absence from
work to be 3,279 euros. Another example of the
prominence of mental disease is bipolar disor-
ders. Almost half (43%) of the patients experi-
encing this disease were absent from work (on
average 55 days per year), resulting in US$ 3,037
productivity costs per person (Hakkaart-van
Roijen et al. 2004). For other diseases that consti-
tute a smaller proportion of sick leave in most
occupational groups, less detailed information is
available from some studies (Goetzel et al. 2004;
Schultz et al. 2009).
3.3.2 Reduced Productivity at Work
The magnitude of reduced productivity at work
(i.e., presenteeism) due to health problems is not
negligible. In an extensive review, Schultz et al.
(2009) reported two nationwide studies among
workers with chronic health problems, and for 11
out of 18 diseases presenteeism exceeded 50% of
to total costs. About 22% of respondents in these
studies reported some time lost to nearly one-
third of adults whose health problems interfered
with their work tasks.
Brouwer et al. (1999) reported in 1999 among
workers in a trade company that 7.9% had reduced
productivity during a week. Nonetheless, this
resulted in less than 1% of working time lost.
Meerding et al. (2005) found that 12% of workers
in high physical load jobs had reduced productiv-
ity. Among those with productivity loss the aver-
age lost work time was 2 h per day. For patients
with low back pain being treated by a physiother-
apist, 52% reported reduced productivity at work,
which resulted in 2 h production loss per day
(Hoeijenbos et al. 2005). For the USA, McDonald
et al. (2011) reported that 30% of workers with
musculoskeletal pain were less productive at
The average annual costs due to lower produc-
tivity at work for patients with subthreshold
depression were estimated to be 3,175 euros
(Smit et al. 2006).
In a study by Lötters et al. (2005) among Dutch
industrial and health care workers, loss in produc-
tivity was measured after returning to work fully
in the regular job after a substantial sick leave
period (median 84 days). Among those with self-
reported productivity (using the QQ method)
(Brouwer et al. 1999; Koopmanschap 2005) the
median of productivity loss on an 8-h working
day due to MSD was 1.6 h shortly after RTW.
A worse physical health, more functional dis-
ability, and a poorer relation with the supervisor
were associated with the presence of productivity
loss shortly after RTW (Lötters et al. 2005). These
ﬁndings correspond to the presenteeism preced-
ing and following absenteeism as illustrated in
the beginning of this chapter. Productivity losses
might occur due to the fact that the worker is not
fully recovered, despite the fact that he has
regained his normal working activity.
All these studies have shown that presentee-
ism contributes substantially to the estimated
total costs of disease among workers. The com-
parability across studies is poor, since methods of
lost productivity and associated costs vary sub-
stantially and are also inﬂuenced by local and
national arrangements with regard to compensa-
tion for illnesses and diseases.
3.3.3 Permanent Disability
Data on permanent disability differ substantially
across countries, as a result of variation in social
security arrangements. Social security arrange-
ments (such as for unemployment or early retire-
ment) may act to some extent as communicating
vessels depending on speciﬁc eligibility criteria.
As with sickness absence rates, the Nordic
European countries also show high disability
353 Work Absenteeism and Productivity Loss at Work
beneﬁt rates going from 7 to 10% of the working
force (WHO 2010). This is reﬂected in the high
proportion of GDP spent on disability and
sickness compensation. While the OECD coun-
tries spent on average approximately 1.9%,
Norway, Sweden, and the Netherlands are clear
outliers with 4.8, 3.6, and 3.7%, respectively.
Compared to countries such as Canada (0.5%)
and United States (1.7%) this is certainly high
(see Chap. 1).
Given the importance of absence from work
and reduced productivity at work as shown above,
it is very surprising that a recent meta-analysis of
economic evaluation studies of health care inter-
ventions targeted at patients with depressive dis-
orders showed that only 25 out of 81 studies
included productivity costs (Krol et al. 2011). As
outlined in the introduction, the decision whether
to include presenteeism in productivity costs has
also compromised comparisons of cost of illness
studies across different diseases. However, given
the importance of productivity costs, we expect
that the number of economic evaluation studies
including both sick leave and productivity loss at
work will increase in the nearby future.
3.4 The Price Component
of Productivity Costs
After correct measuring and estimating, produc-
tivity loss due to health problems should prefer-
ably be valued in monetary terms, in order to
facilitate comparison of costs across disease cat-
egories and intervention programs.
The monetary valuation of productivity loss
has been the subject of considerable debate dur-
ing the last decade (Koopmanschap et al. 1995;
Brouwer et al. 1997). Thus far no complete con-
sensus exists among health economists with
respect to the best approach. The debate on valu-
ation of sickness absence and disability focuses
on the duration of economic consequences to be
considered, as exempliﬁed in the human capital
and friction cost methods. With respect to the
valuation of sickness absence as well as produc-
tivity loss at work another debate centers on com-
pensation mechanisms, whereby productivity is
not (completely) lost but shifted towards a later
period or towards other workers. Hence, we ﬁrst
present the two main methods used to value pro-
ductivity losses and then discuss compensation
3.4.1 The Human Capital Method
The human capital method values total produc-
tion lost due to illness, disability, or premature
death by calculating the total period of absence
(or disability or from death until the retirement
age) and subsequently multiplying this by the
wage rate (or an average expected wage rate for
the relevant period) of the absent worker.
The mainstream neoclassical economic theory
suggests that the productive value of a worker
equals his or her wage rate, at the margin. Since
in the cases of disability or death the patient is
absent for a long period of time, the cost calcula-
tions in these cases will be especially high.
Replacement of workers is not considered to
reduce productivity costs at the societal level in
this method, since full employment is assumed.
In particular, cost calculations for premature
death and disability yield very high results in
this method, and several authors have argued
that the estimations of productivity costs calcu-
lated with the human capital method would be a
maximum estimate, estimating possible produc-
tivity costs rather than actual productivity costs
(Koopmanschap and van Ineveld 1992).
3.4.2 The Friction Cost Method
The criticism of the human capital method is that
it ignores the possibility, at the societal level, that
an absent worker is replaced, and this induces the
development of the friction cost method
(Koopmanschap et al. 1995).
The essence of this method is that absent
workers will be replaced after an adaptation
period (the friction period), and in this way fur-
ther production losses may subsequently be pre-
vented. The friction period was assumed to be
equal to an average vacancy period, the period it
36 M. Koopmanschap et al.
takes to ﬁnd a suitable replacement of an absent
worker on the labor market, plus an additional
period (roughly estimated as 4 weeks) allowing
employers to start searching on the labor market
and training after hiring a new employee
(Koopmanschap et al. 1995). Recently, Erdogan,
Koopmanschap, and Bouwmans estimated the
friction period in ﬁve European countries in 2008
The value of the production losses is not esti-
mated by using wage rates, but by estimating the
added value of a worker. After the friction period,
there are no additional productivity costs, except
for longer-term macroeconomic costs, as rela-
tively high national levels of absence and disabil-
ity from work might raise labor costs per unit of
production which lowers competitiveness on the
world market, limiting export and economic
growth (Koopmanschap et al. 1995). Zhang
et al. (2011) commented that the friction cost
method is not an alternative for the human capital
approach (as suggested by some authors), but a
reﬁnement, as it adjusts for worker replacement
in a friction period. Whether adjustment or
reﬁnement, it should be noted that the estimates
of productivity costs differ substantially between
these methods; see for example Koopmanschap
et al. (1995). (For details on friction and human
capital methods, see Chap. 4.)
3.4.3 The Debate on the Length
of Economic Consequences
The proponents of the human capital approach
and the friction cost method discussed the way to
value productivity costs in the health economic
literature. The main critical remark regarding the
friction cost method was that it would not value
the scarce time sacriﬁced by the person who
replaced the sick worker. However, the friction
cost method assumes that the leisure time
sacriﬁced by the formerly unemployed person
who takes up a new job to replace a worker fallen
ill will be valued in terms of quality of life. At
the level of society, the amount of leisure time
remains the same (the sick worker has more lei-
sure time, the replacer less). The fact that the
sick worker might be less able to enjoy this
increase in leisure time fully is being captured in
terms of quality of life. For further details on this
discussion, see for example Weinstein et al.
(1997), Brouwer et al. (1997), and Zhang et al.
3.4.4 Compensation Mechanisms
It is crucial to understand whether the two main
valuation methods as discussed above may lead
to different approaches to measure and value the
elements of productivity costs, especially short-
term absence from work and reduced productiv-
ity at work. Both approaches need information on
frequency and length of absence from work due
to disease and, when relevant, reduced productiv-
ity at work. However, the friction cost method
leaves open the possibility that work lost during
short-term absence might partially be compen-
sated by the sick worker after return to work or
by colleagues. Hence some authors ask patients/
workers questions regarding these compensa-
tion mechanisms (Jacob-Tacken et al. 2005).
Incorporating these compensation mechanisms
further lowers estimates of productivity costs. On
the other hand, authors as Pauly et al. (2002) state
that absence of speciﬁc crucial workers (e.g., in
small teams) might have multiplier effects on
productivity of others. This would imply that pro-
ductivity loss/costs due to absence of one worker
could be higher than the value of his/her individ-
ual production. When this is relevant in speciﬁc
cases, measurement instruments for productivity
loss should take this into account.
Another element of the working situation of
the sick worker that might affect the magnitude
productivity loss/costs is the relevance of dead-
lines. The more important the deadlines, the less
possibilities to postpone work or compensate
work loss at low cost (Pauly et al. 2002; Nicholson
et al. 2006). Meeting deadlines in case of illness
might necessitate labor reserves within organiza-
tions, which also has costs.
Also workplace-related factors have shown to
be related to productivity loss in general (absen-
teeism and presenteeism), such as lack of control
373 Work Absenteeism and Productivity Loss at Work
on the job, relation with the supervisor, thermal
climate, lightning condition, and regular distur-
bances (Alavinia et al. 2009; Lötters et al. 2005;
Niemela et al. 2002, 2006). Although work-
related factors surely are important to consider
when taken into account, productivity loss, the
severity of health problems, and work limitations
to these problems seem to have more effect on
productivity loss (Alavinia et al. 2009; Lötters
et al. 2005; Meerding et al. 2005).
Reviews about measuring presenteeism show
that several different measurement instruments
are commonly used (Mattke et al. 2007; Zhang
et al. 2011; Schultz et al. 2009), which generate
widely varying estimates of productivity loss
(Zhang et al. 2011). On the basis of the collective
opinion of stakeholder representatives (using the
Delphi method), recommendations for estimat-
ing the cost of productivity loss across all types
of health problems from a company’s perspective
have been formulated for presenteeism. The core
recommendation is to determine the volume of
work loss, and subsequently multiply this vol-
ume by an average or function-speciﬁc (daily or
hourly) salary. Furthermore it is suggested to add
the cost related to coworker overtime, if paid out,
and to subtract the amount of normal working
hours that direct coworkers take over work from
their less effective colleague as a buffer (Uegaki
et al. 2007).
This brings about another discussion around
presenteeism, namely whether or not it is feasible
to monetize the measure of productivity due to
presenteeism loss in a valid and precise way
(Schultz et al. 2009).As appeared from the above-
mentioned Delphi study by Uegaki et al. (2007),
several corrections can be applied on the costs
and consequences calculated from presenteeism;
furthermore, other studies additionally have indi-
cated that other factors such as teamwork deter-
mine the magnitude of the consequences of
presenteeism (Pauly et al. 2008). So the effect of
in different work settings; this hampers a valid
uniform measurement of productivity loss, espe-
cially the presenteeism part.
A related complicated question is how to han-
dle long-term presenteeism. In case of chronic
diseases, workers might be working structurally
below normal standards. According to the human
capital approach, one might hypothesize that the
wage of such workers might be adjusted down-
wards, in order to match their lower productivity.
Applying the friction cost method, it probably
depends on the employer’s response. If the
employer observes the reduced productivity
(sooner or later), he might try to reduce the wage
(or ﬁre the worker) and/or look for another (part-
time additional) worker, who can make up for the
work loss. The amount of productivity costs
involved will depend on many circumstances,
among which the ﬂexibility of the labor market
and the level of unemployment.
There is evidence of a clear downward trend
in career development for people with a health
problem. Considering certain chronic (or long-
lasting) diseases such as depression, rheumatoid
arthritis, and diabetes, it shows that there is clear
work disability due to these diseases (Adler et al.
2006; Baanders et al. 2002; Tunceli et al. 2005;
Lavigne et al. 2003; Ng et al. 2001). For instance,
for diabetes this work disability is due to fatigue
and concentration problems, having to perform
shift-work and suffering diabetes complications
(Baanders et al. 2002;Tunceli et al. 2005; Lavigne
et al. 2003; Ng et al. 2001).
Eventually, these health problems might even
lead to a structural lower number of working
hours as compared to workers without a chronic
health problem; this indeed was shown in a com-
prehensive research among OECD countries con-
ducted by the OECD (WHO 2010). From this
study it appeared that when employed, persons
with disability work part time more often than
other persons in paid employment (10% points)
Another problem around measuring presen-
teeism is the correlation real-time measured pro-
ductivity loss. Only a few studies measured actual
production output and related that to self-reported
38 M. Koopmanschap et al.
measures of presenteeism. In a study among ﬂoor
layers by Meerding et al. (2005), using the QQ
scale (Brouwer et al. 1999), it was shown that
actual production output was signiﬁcantly corre-
lated with the mean self-reported productivity of
the team (r=0.48). However, in the same study it
was not feasible to measure the individual pro-
duction of members of road pavers teams (3–6
persons), which illustrates the complexity of
measuring individual production in many work
settings. In a study by Lerner et al. (2003) among
call center employees using the Work Limitation
Questionnaire (Lerner et al. 2001) as a measure
of productivity loss, it was found that every 10%
increase in the job limitations reported with the
WLQ, the actual production output declined
3.4.6 Expenditure on Social Security
as Proxy for Costs?
It might seem sensible to use the amount of social
security beneﬁts paid related to absence and dis-
ability as a proxy of societal productivity costs.
However, this is not advisable, as the premiums
and beneﬁts are just transfer payments, a redistri-
bution of wealth within society from premium
payers to beneﬁt receivers. For society at large,
this does not represent an economic loss or gain.
What society really loses when workers get ill
and work disabled is the value of production loss,
which decreases wealth and increases the scar-
city of societal resources (Drummond et al.
2005). Besides this redistribution of wealth
within a country it needs to be emphasized that
social security systems across countries differ.
Costs, beneﬁts, and incentives to return to work
(for both employer and employee) can be very
different and subsequently will inﬂuence the
time-window in which this takes place. For
example, in the Netherlands the employer pays 2
years of sick pay before the social security beneﬁt
comes in. So, the incentive for an early return to
work largely falls on the employer. The costs
made in this regard are often not allocated as
being societal costs.
3.5 Productivity Costs,
In economic evaluation studies of health care
programs, taking the societal perspective is
advocated (Drummond et al. 2005). As a conse-
quence, productivity costs, when relevant, should
be included in studies that address the cost-
effectiveness of health and occupational inter-
ventions. Within health care this is quite
straightforward, as the users of these economic
evaluation studies are policymakers, who have
to decide whether to include an intervention in
the basic beneﬁt package that is ﬁnanced by
taxes and/or social security contributions (i.e.,
public resources) (see Chaps. 12, 4, and 23).
But, when the Minister of Health has to choose
between a saving of ten million euros on the
health care budget or a saving of ten million euros
in productivity loss (for society’s wealth at large
it should make no difference), the minister might
prefer the budget saving. This balance might only
be shifted when other parts of the government (or
employer organizations) underline the impor-
tance of the productivity gain. When looking at
occupational interventions, the beneﬁts of an
intervention might be twofold: better health for
the workers and productivity gains for the
employer. When the productivity gains are sub-
stantial and the intervention is not too expensive,
the cost–beneﬁt ratio might be positive for the
organization, which can view it as a sensible pri-
vate investment. In case of net costs and health
gains, the intervention might be cost-effective for
society (it costs, e.g., only 3,000 euros per QALY
gained), but not proﬁtable for the organization to
start up as only investor. An example of a skewed
distribution of cost and beneﬁts is a recent evalu-
ation of interventions for occupational asthma
and rhinitis among bakery workers (Meijster et al.
2011). This study showed that for an intervention
employers were responsible for 63% of the
required investments, but reaped only 48% of the
beneﬁts. In this speciﬁc situation coﬁnancing of
the intervention (or other types of ﬁnancial incen-
tives) by government and/or health insurers might
393 Work Absenteeism and Productivity Loss at Work
facilitate implementation of such a program.
It must be stated that in other situations and juris-
dictions, the distribution of costs and beneﬁts
over stakeholders may be different and, thus, one
would arrive at a different conclusion.
3.6 Discussion and Research
In this paragraph we will brieﬂy discuss the key
ﬁndings and especially the unanswered questions
related to the costs of work absenteeism and pro-
ductivity loss at work.
Reviewing the literature, it is clear that the
costs of disease-related absence from work and
productivity loss at work can be substantial, espe-
cially for musculoskeletal and mental disorders.
However, more information is needed on the work
situations where health problems result in produc-
tivity loss and those work situations where this
will not be the case (van der Berg et al. 2011). The
debate regarding the valuation of absenteeism
reveals that especially the extent of compensation
mechanisms and the impact of team production,
deadlines, etc. on the value of productivity loss
should be considered in future analyses.
In addition, we observed many ways to measure
and value productivity loss at work (presenteeism).
Initiatives to improve the measurement and valua-
tion of presenteeism are currently being undertaken
worldwide. Especially, the measurement and valu-
ation of long-term presenteeism (e.g., due to
chronic and/or episodic disorders) should become
subject of future research, as it might have a sub-
stantial impact on the employability and working
careers of these chronically ill persons.
As observed, the number of cost-effectiveness
studies of occupational health interventions is
growing, but is still too small to guide policy
makers in choosing between interventions. These
cost-effectiveness studies should include produc-
tivity costs (as these are the main cost driver),
which is still not often the case.
Economic evaluation will increasingly play a
role in decisions about provision of occupational
health programs for ill workers or workers on
sick leave. Information on cost-effectiveness of
different intervention programs may guide the
occupational health professional towards
improved decisions regarding priorities in work
rehabilitation. Some caution is required, since the
cost–beneﬁts of an RTW intervention among
workers on sick leave is not only determined by
the estimated effectiveness of the intervention
and associated costs and beneﬁts of the interven-
tion, but also heavily depend on the natural course
of RTW in the target population, the timing of the
enrollment of persons into the intervention, and
the duration of the intervention. These latter three
factors are seldom taken into consideration in
decisions about implementing an RTW program
(van Duin et al. 2010).
The progress in evidence-based occupational
health care will require further development and
reﬁnement of tools and methods used for eco-
nomic evaluation. Insight into the economical
consequences of adverse effects of illness in
addition to consideration of the many work-
related risk factors on workers’ health and dis-
ability can provide unique opportunities to
demonstrate to decision makers in companies
and government the necessity of implementing
workplace interventions and adequate provisions
of occupational health services that can reduce
the burden of work disability.
A complication for policies that potentially
reduce productivity costs is the fact that costs and
beneﬁts (both ﬁnancial and health) often do not
fall upon the same actor, limiting the will to
implement these. There is no simple solution for
this, but showing the total societal gains and
designing (ﬁnancial) incentives for various actors
might help to motivate parties to work towards
common goals. Much more active input from all
parties could facilitate innovative evidence-based
interventions that could pay off!
Adler, D. A., McLaughlin, T. J., Rogers, W. H., Chang, H.,
Lapitsky, L., & Lerner, D. (2006). Job performance
deﬁcits due to depression. The American Journal of
Psychiatry, 163(9), 1569–1576.
Alavinia, S. M., de Boer, A. G., van Duivenbooden, J. C.,
Frings-Dresen, M. H., & Burdorf, A. (2009).
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