Long-term sick leave: a system focused on compliance, not recovery
PhD defence image: Eduardo Ramos via Unsplash+
The Dutch government is considering shortening employer-funded sick pay. But how long should employers pay, and who bears the cost? PhD candidate Thom Wildeboer examined current legislation, finding a system focused more on monitoring than support. He recommends earlier intervention by multidisciplinary teams.
The Wet verbetering poortwachter (Gatekeeper Improvement Act) aims to prevent employees on sick leave remaining out of work for long periods and ultimately ending up on WIA disability benefits, the income support scheme for people who are partially or fully incapacitated for work. The system works well for staff who are off work for a short period: of the roughly 4.2 million sickness notifications each year, 86 per cent of employees are back at work within four weeks, and as many as 97 per cent recover within a matter of weeks. That said, around 80,000 employees remain on sick leave into their second year of absence, and between 20,000 and 30,000 of those on long-term sick leave eventually claim WIA benefits.
‘Focusing on that relatively small group, the actual financial burden on employers is estimated to be around €7.5 billion per calendar year’, Wildeboer says. He found it particularly striking that medical factors become less important the longer someone remains on sick leave, even though interventions are most effective during the first five to six months.
Support or monitor?
The Employee Insurance Agency (UWV) has to assess the efforts of employers and employees and support them in facilitating a return to work. According to Wildeboer, however, the support side often fails to deliver. The UWV is struggling with backlogs and does not prioritise offering support. It chooses to take a much more proactive approach to compliance checks.
If an employer fails to do enough to help an employee return to work, the UWV can impose a wage sanction. The employer then has to keep paying wages for up to an additional year. This has resulted in a widespread fear of sanctions. ‘In practice, the focus is often on how to avoid a wage sanction rather than on achieving the highest possible quality of reintegration.’
Who pays for what?
The fear of sanctions is affecting the entire process, including employees. ‘As the end of the first year of sick leave approaches, tensions rise,’ the PhD candidate explains. The pressure to avoid a sanction ultimately falls on the employee who is off sick, even though around 40 per cent of long-term sickness absence is linked to mental health issues. In addition, nationwide research conducted by the Netherlands Organisation for Applied Scientific Research, TNO, shows that around 75 per cent of these cases are associated with workplace factors, such as an excessive workload and work-related conflicts.
That does little to improve matters. Employers bear what he calls ‘stacked risks’: wages, obligations to get employees back to work, and broader social risks. Employees who are off sick, meanwhile, become increasingly marginalised the longer their absence continues. If a conflict is involved, the situation becomes even more difficult: ‘You can find yourself trapped in a situation that’s almost impossible to escape.’
Multidisciplinary teams can respond faster
In search of an alternative, Wildeboer looked at the system in Denmark. ‘I didn’t use Denmark as a example of good practice, but more as a mirror,’ he says. In the Netherlands, the company doctor (bedrijfsarts), is the key professional who guides the process. In Denmark, by contrast, responsibility for return-to-work support shifts from the employer to the municipality after 30 days, where multidisciplinary teams take charge.
The PhD candidate proposes setting up a multidisciplinary team, for example the company’s bedrijfsarts and an occupational health adviser, after just two weeks to assess what support the employee on sick leave needs. No later than six months into the process, a decision would then be made: either the employee returns to their current employer or begins the process of seeking employment elsewhere. According to 2021 figures, that route is currently successful in only 7 per cent of cases.
Faster intervention, less burden on small businesses
Small businesses have little influence over prolonged sickness absence, yet they still bear the costs and responsibilities. Wildeboer therefore recommends allowing them, after one year, to transfer responsibility to a public employment and reintegration agency. He also argues for a broader definition of ‘work incapacity’. Legislation today says that an employee is considered incapable of work if illness prevents them from working. But Wildeboer proposes taking vocational and labour-market considerations into account, so that an assessment is based not only on what someone can no longer do, but also on what they are still capable of doing.
If the government were to implement just one of his recommendations tomorrow, where should it start? Wildeboer would like to see early intervention and an official decision after six months. ‘I believe that’s where the greatest gains could be made.’ His research suggests that the early involvement of occupational health advisers can make a difference in around one in three cases: ‘So, there are definitely opportunities for improvement there.’
Thom Wildeboer will defend his PhD dissertation ‘Re-integratie van langdurig zieke werknemers’ on 23 October 2026 at 13.00 in the Academy Building. His lay talk on his research is available here and you can follow the livestream of the PhD defence ceremony here.