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June 07, 2002
The Invisible Problem of 'Presenteeism'
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ew study puts a dollar figure on production time lost in the workplace due to employees' common health conditions.

The top five conditions alone, headache/pain, cold/flu, fatigue/depression, digestive problems, and arthritis, cost employers more than $180 billion annually, according to the study, conducted for health-care provider AdvancePCS.

These are the first national estimates that capture the number of hours that U.S. workers lose when they are at work but unable to perform due to health conditions, often called "presenteeism", as well as the hours they are absent due to illness.

Although presenteeism accounts for more than two-thirds of health-related lost labor costs, the impact is often invisible to employers.

AdvancePCS claims the findings are unique in that they capture data on the entire U.S. workforce - not simply selected employers - include information on both presenteeism and absenteeism, and cover health conditions that have an impact on work.

"Employers need to be able to measure the cost burden before they can attempt to manage health problems that lead to lost productive-time," said Walter F. Stewart, Ph.D., M.P.H., vice president of AdvancePCS and director of the AdvancePCS Center for Work and Health. "For the first time, we have a comprehensive understanding of how health conditions impact work performance in the U.S. workforce and more concrete estimates of the related costs. Having this kind of information helps us move beyond the simple recognition that health problems affect work. We now can begin to explore opportunities for achieving a higher return on investment from the health-care dollar."

The analysis is based on data collected over a ten-month period and more than 25,000 interviews as part of the American Productivity Audit (APA). The APA is an ongoing daily national survey of U.S. workers initiated last year by AdvancePCS. Researchers conduct 15-minute telephone interviews with randomly selected individuals who currently are employed and a random sub-sample of those who are not working for pay.

During the interview, researchers collect information on specific illnesses and health conditions the respondent had in the past two weeks. In addition, detailed data are collected on missed days of work and reduced on-the-job performance during the previous two weeks. Interviewees also are asked about the type of work they do as well as salary and demographic information. Cost impact is estimated by multiplying lost-productive-time (absence hours plus hours lost from reduced performance) by the individual worker's hourly labor cost.

Overview of results

- Data from the APA indicate that most people experience one or more common, episodic or chronic-episodic health condition, like headache, other pain, fatigue, or the common cold in any two-week period. More than 70 percent of men and 80 percent of women reported at least one episodic or chronic-episodic health condition in the 2-week period before the interview.

- The majority of people with episodic or chronic-episodic health conditions go to work--they do not stay home. More than 38 percent of women and 28 percent of men reported being at work one or more days during the previous two weeks and not feeling well. Only 7.2 percent of women and 5.3 percent of men actually missed a day of work in the previous 2 weeks for a health reason.

- A majority of the lost productive-time from these health conditions is invisible to employers, because it occurs "on the job." Among those with the episodic or chronic-episodic health conditions, almost three-fourths of their missed time occurs on the job, not from time they miss from work.

- The health conditions workers reported having the most often in the previous two weeks, starting with the most common, include: headache/pain, fatigue, sad or blue, arthritis, nasal allergies, digestive problems, menstrual-related, cold/flu, asthma/skin allergies, dental problems, and prescription side effects.

- Of the most common health conditions, the top five that are the most costly in terms of lost productive-time are headache/pain, cold/flu, fatigue/sad-blue, digestive problems, and arthritis. The total cost to employers for these 5 conditions alone is more than $180 billion per year. (For purposes of analysis, "fatigue" and "sad/blue" are combined because a portion of fatigue is a consequence of depression. Sad/blue is an indicator for diagnosis of depression. Follow-up studies are in progress to determine what percentage of workers reporting feeling sad/blue or fatigue meet diagnostic criteria for depression.)

- On average, a worker in the U.S. loses 115 productive work hours every year due to a health condition (this includes chronic, as well as episodic and chronic-episodic conditions.) Furthermore, for any one condition, 70 percent to 80 percent of the lost time is concentrated in 20 percent to 35 percent of employees.

- The annual cost to employers for all health conditions (i.e. including chronic in addition to episodic and chronic-episodic) is $250 billion or more. The total cost to employers in lost productive-time for all conditions is in the range of $2000 per worker per year.

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