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Physicians, sick leave certificates, and patients' subsequent employment outcomes.

ABSTRACT: I analyze how general practitioners (GPs) indirectly affect their patients' employment outcomes by deciding the length of sick leaves. I use an instrumental variables framework where spell durations are identified through supply-side certification measures. I find that a day of sick leave certified only because the worker's GP has a high propensity to certify sick leaves decreases the employment probability persistently by 0.45-0.69 percentage points, but increases the risk of becoming unemployed by 0.28-0.44 percentage points. These effects are mostly driven by workers with low job tenure. Several robustness checks show that endogenous matching between patients and GPs does not impair identification. My results bear important implications for doctors: Whenever medically justifiable, certifying shorter sick leaves to protect the employment status of the patient may be beneficial.

SUBMITTER: Ahammer A

PROVIDER: S-EPMC5947550 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Physicians, sick leave certificates, and patients' subsequent employment outcomes.

Ahammer Alexander A

Health economics 20180324 6

I analyze how general practitioners (GPs) indirectly affect their patients' employment outcomes by deciding the length of sick leaves. I use an instrumental variables framework where spell durations are identified through supply-side certification measures. I find that a day of sick leave certified only because the worker's GP has a high propensity to certify sick leaves decreases the employment probability persistently by 0.45-0.69 percentage points, but increases the risk of becoming unemploye ...[more]

PMID: 29573056

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Project description:ObjectivesTo explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text).DesignA nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway.SettingPrimary care.ParticipantsPatients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020.ResultsOf the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001).ConclusionsPatients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.

Project description:BACKGROUND:Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians. METHODS:A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions. RESULTS:The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p < 0.05). Attitudes and subjective norms were identified as important predictors in physician intention to provide sick leave to patients. CONCLUSION:An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help regulate the provision of sickness leave and alleviate the work burden of sickness leave tasks faced by physicians in Malaysia.

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Physicians, sick leave certificates, and patients' subsequent employment outcomes.

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Physicians, sick leave certificates, and patients' subsequent employment outcomes.

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