Dutch doctors fight law on sick pay

BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:142

Dutch doctors are leading a campaign against a proposed law privatising payments to sick employees by shifting the burden for the first year's sickness from the government to the employer. They fear that it will undermine the independence of doctors and lead to staff selection on health grounds.

Under the proposed law employers must pay at least 70% of the wages of ill staff for 52 weeks instead of only the first six weeks. The government believes that by confronting employers with the financial cost of sick leave it will force them to take steps to maintain the health of employees. It expects a 10% drop in sickness absence, saving pounds sterling230m ($345) from the social security budget.

The Netherlands became famous for high levels of sick leave when levels reached 8.2% of the working population by 1994. Absenteeism has dropped to 4.8% since a new law obliging employers to pay wages for the first six weeks of sickness was introduced. Now doctors fear that the proposed, extended law would amount to “overkill.”

The Royal Dutch Medical Association last week urged the Dutch senate to delay the bill, which is due to become law on 1 February. The association is seeking an evaluation of the “far reaching consequences” of the proposed law.

In the Netherlands sick notes are not written by a patient's general practitioner but by company doctors employed by private organisations providing occupational medicine. These organisations must win contracts with employers, who will have a financial incentive under the proposed new law to reduce sickness levels.

The association's secretary general, Dr Theo van Berkestijn, argued that to improve employees' health company doctors needed to be able to speak confidentially with the patients' general practitioners. But he fears that this law could make company doctors feel caught between financial pressure from the employer and caring for their patients.

Occupational physician Professor Frank van Dijk of Amsterdam's Academic Medical Centre said, “We are afraid that people with chronic conditions or a history of illness will have enormous problems finding jobs. Employers will try to select on health grounds because they do not want the risk,” he said.—TONY SHELDON, freelance journalist, Utrecht