Along with pensions, medical leave or, more technically speaking, temporary disability, has become one of the largest costs for the so-called welfare system and also one of the most difficult to manage. In this sense, the Independent Authority for Fiscal Responsibility, the (AIReF), has prepared a report in which it estimates that the disbursement linked to this benefit reached 16,464 million euros in 2024. As we say, it is the second largest component of Social Security spending after pensions.
In an evaluation included in the Spending Review 2022-2026the organism focuses on a structural deficiency of the model. The person who decides clinically on sick leave is, generally, the primary care of the National Health System. But the one who assumes the cost is the National Social Security Institute, the INSS. This separation between clinical authority and financial responsibility, he warns, increases the risk of overuse or unnecessary extensions if there is no stronger coordination and supervision.
Who is most likely to initiate a leave?
Episodes of temporary disability due to common contingencies rose from 4.7 million in 2017 to almost 8.6 million in 2024. Beyond the total, the report identifies factors that significantly increase the probability of starting a process. The most determining factor is having already been on sick leave the previous year. This background increases the probability by 250%, keeping the rest of the characteristics constant.
In the report, clear patterns can be seen, such as that the probability is greater in women, 21% more than in men, and in those under 40 years of age, 20% more. It is also higher in public sector workers, 14% more. The company variable also matters. Those who work in large companies register a higher probability, 81% more than in micro-businesses.
The salary level adds another nuance. The report detects a greater probability in those who are in a medium salary range, with 52% more than in the first quartile.
The increase in incidence and the cycle factor
The diagnosis is not limited to who, but to how much and how it evolves, since AIReF estimates that the incidence of temporary disability due to common contingencies rose from 21.4 to 33.9 cases per 1,000 affiliates between 2017 and 2024. It is a cumulative growth of 58.4%. The incidence is procyclical, which means that it increases in bullish phases and reduces in contractionary phases.
In parallel, the organization points to a part of the increase that is not explained by observable factors. In 2024, the models predict 11% less temporary disability than what was finally observed.
Durations with almost 46 days on average and maximums in mental health
The average duration of processes due to common contingencies was 45.9 days in 2024, compared to 40 days in 2017. However, the average hides large differences by diagnosis. The AIReF points out that mental disorders are those that accumulate the longest durations. They go from 67 days in 2017 to 98.5 days in 2024.
The report incorporates two trends at the same time. In 2024, more than 65% of episodes lasted less than 15 days. But very short losses, of less than three days, and very long losses, of more than 365 days, are also growing strongly in the period 2017-2024.
The evaluation detects an increasing concentration. 25% of people accumulated 51% of the episodes in 2017. That proportion increased to 55% in 2024.
In addition, the percentage of those who chain more than one episode per year increases. It goes from 23% in 2017 to 31.8% in 2024.
How to pay leave for common contingencies
The economic operation of the service maintains the classic structure. The first three days there is no benefit. From the 4th to the 15th the company pays. Starting on the 16th, the General State Administration assumes payment, through the INSS or a mutual insurance company, through the delegated payment system.
In terms of amount, the legal scheme for common contingencies places 60% of the regulatory base between days 4 and 20 and 75% from day 21.
One of the sensitive points of the analysis is the effective generosity of the system when collective agreements come into play. AIReF estimates that approximately 50% of sectoral agreements and 65% of company agreements include remuneration supplements that increase financial coverage during temporary disability.
On average, in agreements with improvements, the final amount is 80% of the regulatory base on days 1 to 3, compared to the legal 0%. Between days 4 and 20 it reaches 91%, compared to the legal 60%. As of the 21st it reaches 97%, compared to the legal 75%.
What AIReF proposes
With this framework, AIReF proposes a package of measures that does not aim to cut rights, but rather to increase the effectiveness of management. The main one is to move towards an integrated and interoperable information system between the INSS, regional health services, mutual societies and companies.
In parallel, it proposes strengthening the capabilities of the INSS to act sooner in control and monitoring. It also proposes providing primary care with systematic information on the worker’s working conditions, reinforcing the connection with medical inspections and specialized units.