Belgium – the Netherlands: lessons on absenteeism that we can share with one another

"There are very few companies that naturally have a low absenteeism rate, without making efforts to achieve this," asserts Reijer Pille, director of Falke & Verbaan Groep. "Absenteeism is always an indicator of the state of affairs in the workplace. And by extension in society."

Originally as a physician, Reijer specialised in social medicine and worked for many years as a physician and director in occupational health and safety services(*). He collaborated on the first ministerial regulation, the foundation of the Dutch Gatekeeper Improvement Act. He also has several publications on his name concerning Dutch absenteeism and the health and safety market.

(*) Health and safety services in the Netherlands assist organisations without an internal company physician to comply with the legal obligations concerning absenteeism, including reintegration and continued payment of wages.

In the early 1990s, the number of people unable to work reached an unprecedented peak in the Netherlands. In the following years, the government worked on drastic changes in social security, including the Gatekeeper Improvement Act (applicable as of 1 April 2002).

This requires Dutch employers to carry on paying their employees suffering from illness 70% of their final salary for two years. If employers cannot prove that they have made sufficient efforts together with the employee and under the supervision of the company physician or the occupational health and safety service, a third year is added on.

From the onset of the illness, a rigorously organised procedure unfolds, including the analysis of the problem, a plan of action, analysis and evaluation moments. All with one objective in mind: to accelerate the return to work. Either in the existing job, or with an adjusted task package or with another employer.

At Falke & Verbaan Groep, which advises companies on absenteeism and sustainable employability, they take a behavioural view of absenteeism. Reijer: “The decision to take a leave of absence is largely determined by the social environment, including the work environment itself. So absenteeism can be influenced by the way employer and employee behave towards one another."

Absenteeism as a result of decision-making processes is also the common thread throughout the book "Verzuim. Maak er werk van!" by absenteeism expert Bart Teuwen. Bart is director at Certimed, which assists companies with medical examinations. Until 2016, he spent most of his career in the Netherlands working as a company physician. Before returning to Belgium, he headed an occupational health and safety service.

Bart: “By considering absenteeism as a form of behaviour, you take it out of the medical sphere. Consequently, as an employer, you can discuss the issue with your employee, which is crucial for mutual trust. This bond of trust makes you work together to seek solutions even in moments of crisis. In the absence of trust, absenteeism is the logical escape route."

How do Belgium and the Netherlands compare today in terms of absenteeism figures?

Bart: "In our country, red lights have been flashing for quite some time. Belgium is at the head of the European absenteeism league table, with government expenses reaching 21 billion euros. Absenteeism therefore puts our entire social security system under severe pressure. We are in the same boat as the Netherlands were in the 1990s. The peak that absenteeism reached there then led to a transformation of social security at the turn of the century."

Reijer: "With success! Until say 2015, the heavy financial penalties and the reintegration obligation caused a spectacular drop in absenteeism. Unfortunately, that effect appears to be wearing off. Meanwhile, Dutch sick leave expenses are already running at 24 billion. Particularly in healthcare, education and government, long-term absenteeism has risen dramatically, which is no coincidence in sectors with large staff shortages - partly due to an ageing population."

Is the Dutch approach in need of adjustement?

Reijer: “Over the years, there has been a strong juridification and medicalisation of absenteeism support. Health and safety services are seen as an extension of social security. Consequently, the focus gradually shifted from avoiding absenteeism to preventing wage sanctions.

The result: company physicians and health & safety services are struggling with the case load and the handling of legal claims. From employers challenging wage sanctions, for instance. Or from employees complaining about the company physician's support. This regulatory frenzy increasingly distracts us from the essence of a successful approach to absenteeism: getting people back to work and keeping them there. Today, this is reflected in the rising absenteeism figures."

Getting people back to work after a long period of absence is proving particularly difficult in Belgium. Can we draw inspiration from the Dutch reintegration requirement?

Bart: “Definitely. Various scenarios are possible here, from resuming the existing job over a modified task package to leaving the job to start working for another employer. The employer, employee and company physician are jointly responsible from the outset of the absence period.

In our country, this kind of pathway is still in its infancy. A new law encourages employers to invest more in reintegration. This also brings the occupational physician more into the picture. Hopefully, the black-and-white mentality - either you are ill or you are not - will gradually give way to an open conversation about the possibilities that an individual does still have."

Another fundamental difference between Belgium and the Netherlands: the doctor's note.

Bart: "Our medicalisation of absenteeism is perhaps the most interesting difference, because it has left a heavy mark on the Belgian absenteeism culture. In our country, the sick note stands like a wall between employer and employee. Those who are sick are not allowed to work. As soon as a GP makes that diagnosis, as an employer you feel that all you can do is wait and see how things unfold. In the Netherlands, on the other hand, a dialogue between employer and employee, supported by the company physician, occurs from the start of the absence period."

Reijer: "Dialogue is the basis for reducing absenteeism. It starts from the moment you pick up the first signals as an employer. People are sometimes struggling to cope, or they have lost control of their careers. They lose confidence in their abilities and need guidance to find their way back. At that point, your door should already be open, otherwise all manner of symptoms will eventually push them towards absenteeism. Yet that is precisely where I think our Dutch approach has fallen short in recent years."

As a Dutch absenteeism expert, how do you view absenteeism prevention in Belgium?

Reijer: "In addition to reintegration, I consider prevention to be the key to a sustainable approach to absenteeism. In that respect, the Netherlands can learn from the Belgians. Just think of the compulsory risk analyses on the workfloor. These exist in both countries, but Belgium started much earlier with the strong focus on psychosocial well-being. Consider, for instance, the acknowledgement of burnout as a work-related illness. My assessment is therefore that the Belgian and Dutch absenteeism approaches will eventually converge."

What are the main challenges for employers in shaping their absenteeism policy?

Reijer: "In my opinion, the number one challenge is to keep your employees motivated in today's limited labour market. People look at work differently than they did a few decades ago. The youngest generation in particular has high demands in terms of work-life balance, autonomy and how they perform their tasks. Combating absenteeism is a matter of retaining employees with a flexible work culture."

Bart: "Sometimes I think back to the flexibility we had suddenly gained during the covid period - but are now gradually losing again. Many rules had to be thrown overboard during the lockdowns. A considerable risk for employers, but at the same time many organisations suddenly gained wings. We must have the courage to maintain this flexibility to achieve real change in the workplace and keep people happily employed, both today and tomorrow."