Sickness absence has become a growing public health challenge in Western societies over the last decades
[1–3]. In both Norway and Denmark, the highest sickness absence rates are found in the health and care sectors
[4–6]. The economic burden of sickness absence is considerable, and authorities in both countries want to reduce these costs.
Some of the first comparable statistics for sickness absence rates in Norway and Denmark were recorded in 1987, and data from this time and thereafter consistently showed higher rates in Norway than in Denmark
[7–9]. The trend in sickness absence from 1987 to 2009 showed a relatively large variation in sickness absence rates in Norway (from approximately 2.5% to 4%) compared to Denmark, where sickness absence rates were far more stable (from approximately 1.6% to 1.9%)
[7, 9, 10]. These numbers were taken from the Labour Force Surveys and indicate the level of sickness absence measured as a rate
[7, 11]. Currently, the sickness absence rate in Norway is among the highest in Northern Europe, whereas Denmark has far lower rates
. However, the sickness absence rates during the last 5 years have decreased slightly in all age groups in Norway, and have increased in all age groups in Denmark
[13, 14]. Although sickness absence patterns among employees in the health and care sectors have been explored only to a limited extent, previous international studies have indicated increasing rates with age
Sickness benefit policies are important factors in explaining sickness absence patterns. A comparison of these policies in Norway and Denmark might contribute to a better understanding of the underlying causes of sickness absence in the two countries
[1, 8, 11]. Unfortunately, we have not found any comparative studies of sickness absence in the health and care sector from other countries.
Sick leave regulations in Norway and Denmark, which apply to all employees, share some common features: the initial compensation rate is 100%, and there is no waiting period. The employer finances the compensation during the first 16 days of sick leave in Norway, and for the first 14 days, which was extended to 21 days in 2008, in Denmark. After the employer compensation period expires, compensation is fully or partly paid by the public authorities
[16–18]. The maximum duration one can receive compensation while on sick leave is 1 year in both countries. It is possible to extend this duration in Denmark if the relevant authorities or a physician require on-going evaluations of work capacity and if the employee is awaiting medical treatment, has a work injury claim in progress, or has a deadly disease. The weekly maximum disbursements for sick leave compensation are higher in Norway than in Denmark
[8, 16]. However, as all government employees, those in the health and care sector in Denmark receive full pay during sick leave, and thus have no more economic incentive to reduce their absenteeism than their counterparts in Norway. Regulations concerning job security are different in Norway and Denmark
[8, 18, 19]; employees in Denmark might lose their job while on sick leave. Sickness absence tends to be negatively correlated with unemployment, and the unemployment level in Denmark has been higher than that in Norway for several years
Previous studies have shown variation in sickness absence by age
[7, 23–25]. According to the European Working Conditions Observatory
, the total level of sickness absence decreased between 2003 and 2008 in Norway in all age groups. The same observatory
 reported a slightly increasing trend of sickness absence between 2003 and 2008 in Denmark. It has been reported that older employees tend to have more sickness absence than younger employees
, and larger age differences in sickness absence rates have been shown in Norway than in Denmark
. In Norway, the sickness absence rates increased with age, while in Denmark, the rates decreased in the 60–67-year-old age group compared to the 50–59-year-old age group
. Moreover, the mean number and frequency of sick leave episodes slightly increased in Norway between 1975 and 2002
. Comparisons between countries may be impeded by differences in the size of a given industry, and the sex, age, etc., of its employees
. Strict comparisons cannot be made unless employees are selected from the same industry and have the same type of job. Therefore, we have chosen to study the health and care sectors in Norway and Denmark as we consider the work tasks to be comparable across countries. The municipal health and care sectors include, for example, nursing homes, home care services, and day centers. This study is a part of a larger study where background variables, such as occupation, age, and percentage of employment, were investigated
. In this study, we focus on sickness absences patterns and trends over a 5-year period, overall and by age group.
The aim of this comparative study was to assess the development in sickness absence rates, short-term and long-term absence, and frequency of sick leave episodes from 2004 to 2008 in the health and care sectors in the cities of Kristiansand, Norway, and Aarhus, Denmark.