ONE fear has dominated the ongoing debate on whether workers should be able to take sick leave without a medical certificate (MC): If taking sick leave becomes easier, more people will do it.
By Janice Heng
It seems like common sense. But that fear rests on assumptions which can be questioned, and may also draw attention away from the potential benefits of switching to a no-MC system.
Under the Employment Act, which will be reviewed this year, workers are entitled to paid sick leave if it is certified by a doctor.
Last month, general practitioner David Tan Hsien Yung wrote to The Straits Times Forum Page to suggest removing the need for certification.
Instead, bosses can trust employees to be honest when calling in sick. In San Francisco, which Dr Tan had visited, giving uncertified sick leave is common.
In a Straits Times report last week, most bosses interviewed were not in favour of an honour system. The fear is that without the need for an MC, staff will malinger or feign illness to skip work.
Realistically, that already happens.
Doctors say they see more MC-seekers on Mondays and Fridays, when a day off means a long weekend.
Numbers also pick up during major sporting events such as the World Cup.
So the question is not whether workers will abuse medical leave. It seems some will, and already do.
The real question is whether allowing uncertified medical leave will cause more to do so. Will it?
Common sense would tell us that people who are wont to fake illness will continue to do so, with or without the need for an MC. The only difference is if an MC is done away with, they can call in sick without going through the charade of consulting a doctor.
That has the unintended benefit of reducing the load on the health-care system. Employees with genuine but minor ailments can also avoid a trip to the doctor, further easing the health-care crunch.
Doctors and health-care experts have noted that many patients are educated working adults who could buy medication from retail pharmacies - but go to the doctor because they need an MC.
'Imagine how many truly ill people I could have attended to instead,' former public health practitioner Irwin Clement Chung wrote in a Forum letter.
Subsidised polyclinics have long been put under stress by high patient volume, and the Government has been seeking ways to alleviate this.
National Healthcare Group said its po-lyclinics do not regularly collate data on MC numbers, nor do they track cases that only require home rest. But surely every little bit will help in lessening the load.
The cynic might ask: What about the borderline cases? Will more workers be tempted to skive by calling in sick without the need for an MC?
At first glance, it might appear that not having to spend time and money seeing a doctor should make it more attractive to fake illness and take sick leave.
But advanced economic theories suggest this might not be so. Some studies find that a penalty - or cost - can encourage behaviour it is meant to deter.
Israeli economists Uri Gneezy and Aldo Rustichini looked at day-care centres which fined parents for picking up their children late. After the fine began, more parents began turning up late.
Many other studies have shown that rewards or penalties can have the opposite effect from that intended, as they 'crowd out' intrinsic motivation. One found that volunteers put in less effort when paid, possibly because that makes them see the act as a transaction, not an altruistic gesture.
Similarly, the externally imposed cost of getting an MC may weaken the internal safeguards of conscience.
An employee might feel uncomfortable calling his boss and lying about sickness. But an official MC may make him feel he has 'paid for' the right to skive. He might think, 'I've seen a doctor and paid so much, what's wrong with taking MC?'
If borderline cases are already malingering, then allowing no-MC sick leave will not convince many new people to malinger. Absenteeism will not rise much.
Another Forum contributor's story bears this out. Ten years ago, Mr Amarjit S. Wasan's organisation started allowing uncertified sick leave of up to three days.
At first, there was a 'minor spike' in cases. But the rise was not sustained over time, and cases of abuse were few.
Bosses fearful of trying the honour system may be overestimating the potential increase in absenteeism.
Instead, a liberal sick leave regime can boost productivity, as ill workers stay home instead of spreading their germs around the office.
According to a 2009 report by the McGill University Institute of Health and Social Policy and the Harvard School of Public Health, companies incur higher costs from sick employees coming to work, compared to the costs of sick leave.
Secondly, even if absenteeism goes up, it can be mitigated. Supporters of uncertified sick leave have all noted the need for safeguards. These can include limiting the amount of uncertified sick leave, for example, to three consecutive days, and seven days a year. The total amount of sick leave can also continue to be capped at 14 days a year.
Some have suggested taking sick leave into account during performance appraisals, to discourage malingering and give employees an incentive to look after their health. But this would unfairly penalise the truly ill or spur them to turn up while sick, which benefits neither worker nor employer.
A hard look at this issue requires the weighing of potential danger of increased absenteeism against the direct and likely benefits.
Workers will save time and money, and can better recuperate at home.
Bosses will save on co-payments for their staff's medical bills, and might build better employee trust and morale.
The general public is less exposed to germs, as sick workers do not need to make the trek to clinics.
Polyclinics will have lighter loads.
And patients who do need a doctor's personal attention will receive it faster.
There is one group which has cause to fear: GPs, for whom MC-seekers may be a key clientele.
Yet it was a GP who first ignited the debate - a fact that should give naysayers pause.