Apa tujuan dari tinjauan ini?
Untuk mengetahui apakah terdapat kemungkinan mempengaruhi ketidakhadiran karena sakit dengan mengubah lama waktu pekerja diperbolehkan mengambil cuti karena sakit tanpa surat dokter. Kami menemukan lima penelitian.
Pesan utama
Kami tidak yakin apakah mengubah lama waktu pekerja diperbolehkan mengambil cuti karena sakit tanpa surat dokter memiliki pengaruh terhadap ketidakhadiran karena sakit, karena penelitian yang disertakan melaporkan hasil yang sangat berbeda, dan kepastian bukti ilmiahnya rendah hingga sangat rendah.
Apa yang diteliti dalam tinjauan ini?
Ketidakhadiran karena sakit membuat seseorang tidak dapat bekerja dan dengan demikian dapat mengurangi pendapatan dan menyebabkan kerugian bagi pemberi kerja. Biasanya pemberi kerja meminta surat keterangan dokter untuk menyatakan ketidakhadiran karena sakit. Hal ini mungkin tidak berarti dalam kasus penyakit yang tidak terlalu parah yang dapat sembuh secara cepat dengan istirahat. Cuti sakit tanpa surat dokter untuk ketidakhadiran karena sakit telah digunakan di banyak tempat kerja untuk periode ketidakhadiran karena sakit yang biasanya berlangsung dari satu hari hingga dua minggu. Dalam tinjauan ini, kami mengevaluasi bagaimana perubahan dalam panjangnya cuti sakit tanpa surat dokter memengaruhi rata-rata jumlah hari absen karena sakit, jumlah periode absen karena sakit, dan jumlah waktu kerja yang hilang di tempat kerja.
Mengapa topik ini penting?
Ketidakhadiran karena sakit sangat merugikan masyarakat dan perusahaan. Pemberi kerja mungkin harus terus membayar gaji karyawan yang sakit. Setelah kewajiban pemberi kerja untuk membayar berakhir, asuransi menanggung tunjangan sakit. Mengubah praktik surat dokter dengan absen sakit yang singkat diharapkan dapat mengubah sikap dan perilaku karyawan, kerja sama dan iklim di tempat kerja, serta mengurangi ketidakhadiran karena sakit. Cuti sakit tanpa surat dokter membuat lebih banyak sumber daya perawatan kesehatan tersedia untuk tujuan lain.
Apa hasil utama dari tinjauan ini?
Kami menemukan lima penelitian yang dilakukan antara tahun 1969 dan 2014. Sebuah penelitian mengevaluasi efek dari memperpanjang periode cuti sakit tanpa surat dokter di antara semua pekerja yang diasuransikan di sebuah kota besar dan wilayah di Swedia pada tahun 1988. Tiga penelitian mengevaluasi efek dari perpanjangan periode cuti sakit tanpa surat dokter bagi karyawan di beberapa kota di Norwegia. Sebuah penelitian mengevaluasi efek dari pengenalan cuti sakit tanpa surat dokter di sebuah organisasi di Inggris pada tahun 1969. Waktu peserta dalam kelompok intervensi diizinkan untuk tidak bekerja tanpa surat dokter berkisar antara tiga hari hingga satu tahun. Studi yang disertakan mengukur efek pada rata-rata jumlah hari absen karena sakit, jumlah periode absen karena sakit, atau waktu kerja yang hilang karena periode absen karena sakit. Semua penelitian membandingkan efek dari perubahan tersebut dengan praktik seperti biasa.
Efek pada durasi periode ketidakhadiran karena sakit
Memperpanjang cuti sakit tanpa surat dokter dari satu minggu menjadi dua minggu meningkatkan durasi rata-rata ketidakhadiran karena sakit. Memperkenalkan cuti sakit tanpa surat dokter selama maksimal tiga hari mengurangi durasi rata-rata ketidakhadiran karena sakit yang berlangsung hingga tiga hari. Memperpanjang cuti sakit tanpa surat dokter dari satu hingga tiga hari hingga satu tahun tidak mengubah durasi ketidakhadiran karena sakit.
Efek pada jumlah periode ketidakhadiran karena sakit
Memperpanjang cuti sakit tanpa surat dokter dari satu minggu menjadi dua minggu tidak mengubah jumlah periode absen karena sakit. Memperkenalkan cuti sakit tanpa surat dokter untuk maksimum tiga hari meningkatkan periode ketidakhadiran karena sakit hingga tiga hari. Memperpanjang cuti sakit tanpa surat dokter dari tiga hari hingga satu tahun mengurangi periode absen karena sakit.
Efek pada waktu kerja yang hilang
Memperpanjang cuti sakit tanpa surat dokter dari satu minggu menjadi dua minggu menyebabkan peningkatan waktu kerja yang hilang. Memperpanjang cuti sakit tanpa surat dokter (dari nol hari menjadi tiga hari dan dari tiga hari menjadi lima hari) meningkatkan jumlah waktu kerja yang hilang karena periode absen karena sakit yang berlangsung hingga tiga hari. Memperpanjang cuti sakit tanpa surat dokter dari ≤ 3 hari menjadi ≤ 50 hari dan dari ≤ 3 hari menjadi ≤ 365 hari mengurangi waktu kerja yang hilang karena periode ketidakhadiran karena sakit selama 4 hingga 16 hari dan > 16 hari.
Biaya ketidakhadiran karena sakit dan surat dokter
Biaya tunjangan ketidakhadiran karena sakit yang diakibatkan oleh periode cuti sakit tanpa surat dokter yang lebih lama dapat mencapai sekitar enam kali lebih besar dibandingkan dengan kemungkinan pengurangan biaya karena berkurangnya jumlah perjanjian dengan dokter.
Seberapa mutakhir tinjauan ini?
Kami melakukan pencarian penelitian hingga 14 Mei 2018.
Read the full abstract
From the societal and employers' perspectives, sickness absence has a large economic impact. Internationally, there is variation in sickness certification practices. However, in most countries a physician's certificate of illness or reduced work ability is needed at some point of sickness absence. In many countries, there is a time period of varying length called the 'self-certification period' at the beginning of sickness absence. During that time a worker is not obliged to provide his or her employer a medical certificate and it is usually enough that the employee notifies his or her supervisor when taken ill. Self-certification can be introduced at organisational, regional, or national level.
Tujuan
To evaluate the effects of introducing, abolishing, or changing the period of self-certification of sickness absence on: the total or average duration (number of sickness absence days) of short-term sickness absence periods; the frequency of short-term sickness absence periods; the associated costs (of sickness absence and (occupational) health care); and social climate, supervisor involvement, and workload or presenteeism (see Figure 1 ).
Metode penelusuran
We conducted a systematic literature search to identify all potentially eligible published and unpublished studies. We adapted the search strategy developed for MEDLINE for use in the other electronic databases. We also searched for unpublished trials on ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We used Google Scholar for exploratory searches.
Kriteria seleksi
We considered randomised controlled trials (RCTs), controlled before-after (CBA) studies, and interrupted time-series (ITS) studies for inclusion. We included studies carried out with individual employees or insured workers. We also included studies in which participants were addressed at the aggregate level of organisations, companies, municipalities, healthcare settings, or general populations. We included studies evaluating the effects of introducing, abolishing, or changing the period of self-certification of sickness absence.
Pengumpulan data dan analisis
We conducted a systematic literature search up to 14 June 2018. We calculated missing data from other data reported by the authors. We intended to perform a random-effects meta-analysis, but the studies were too different to enable meta-analysis.
Hasil utama
We screened 6091 records for inclusion. Five studies fulfilled our inclusion criteria: one is an RCT and four are CBA studies. One study from Sweden changed the period of self-certification in 1985 in two districts for all insured inhabitants. Three studies from Norway conducted between 2001 and 2014 changed the period of self-certification in municipalities for all or part of the workers. One study from 1969 introduced self-certification for all manual workers of an oil refinery in the UK.
Longer compared to shorter self-certification for reducing sickness absence in workers
Outcome: average duration of sickness absence periods
Extending the period of self-certification from one week to two weeks produced a higher mean duration of sickness absence periods: mean difference in change values between the intervention and control group (MD perubahan ) was 0.67 days/period up to 29 days (95% confidence interval (95% CI) 0.55 to 0.79; 1 RCT; low-certainty evidence).
The introduction of self-certification for a maximum of three days produced a lower mean duration of sickness absence up to three days (MD perubahan −0.32 days/period, 95% CI −0.39 to −0.25; 1 CBA study; very low-certainty evidence). The authors of a different study reported that prolonging self-certification from ≤ 3 days to ≤ 365 days did not lead to a change, but they did not provide numerical data (very low-certainty evidence).
Outcome: number of sickness absence periods per worker
Extending the period of self-certification from one week to two weeks resulted in no difference in the number of sickness absence periods in one RCT, but the authors did not report numerical data (low-certainty evidence).
The introduction of self-certification for a maximum of three days produced a higher mean number of sickness absence periods lasting up to three days (MD perubahan 0.48 periods, 95% CI 0.33 to 0.63) in one CBA study (very low-certainty evidence).
Extending the period of self-certification from three days to up to a year decreased the number of periods in one CBA study, but the authors did not report data (very low-certainty evidence).
Outcome: average lost work time per 100 person-years
Extending the period of self-certification from one week to two weeks resulted in an inferred increase in lost work time in one RCT (very low-certainty evidence).
Extending the period of self-certification (introduction of self-certification for a maximum of three days (from zero to three days) and from three days to five days, respectively) resulted in more work time lost due to sickness absence periods lasting up to three days in two CBA studies that could not be pooled (MD perubahan 0.54 days/person-year, 95% CI 0.47 to 0.61; and MD perubahan 1.38 days/person-year, 95% CI 1.16 to 1.60; very low-certainty evidence).
Extending the period of self-certification from three days up to 50 days led to 0.65 days less lost work time in one CBA study, based on absence periods lasting between four and 16 days. Extending the period of self-certification from three days up to 365 days resulted in less work time lost due to sickness absence periods longer than 16 days (MD perubahan −2.84 days, 95% CI −3.35 to −2.33; 1 CBA study; very low-certainty evidence).
Outcome: costs of sickness absence and physician certification
One RCT reported that the higher costs of sickness absence benefits incurred by extending the period of self-certification far outweighed the possible reduction in costs of fewer physician appointments by almost six to one (low-certainty evidence).
In summary, we found very low-certainty evidence that introducing self-certification of sickness absence or prolonging the self-certification period has inconsistent effects on the mean number of sickness absence days, the number of sickness absence periods, and on lost work time due to sickness absence periods.
Kesimpulan penulis
There is low- to very low-certainty evidence of inconsistent effects of changing the period of self-certification on the duration or frequency of short-term sickness absence periods or the amount of work time lost due to sickness absence. Because the evidence is of low or very low certainty, more and better studies are needed.
Diterjemahkan oleh dr. Johannes Paulus Fernandez (Universitas Indonesia). Disunting oleh dr. Ajeng Viska Icanervilia, MPH, PhD (Universitas Gadjah Mada). Email Kontak : cochrane-indonesia.fkkmk@ugm.ac.id.
