Использование показателя временной нетрудоспособности в практике управления здравоохранением в зарубежных странах

Введение. Ввод целевого показателя «Снижение к 2030 г. суммарной продолжительности временной нетрудоспособности граждан в трудоспособном возрасте…» может быть интерпретирован как установка на увеличение роли системы здравоохранения в создании совокупной валовой добавленной стоимости, поскольку состояние здоровья людей определяет качество кадрового потенциала страны, непосредственно влияя на производительность труда  и определяя перспективы экономического роста.

 Цель исследования – обзор зарубежных публикаций, отражающих использование показателя временной нетрудоспособности в практике управления здравоохранением в зарубежных странах.

Материалы и методы. Представлен литературный обзор результатов научных исследований на основе источников, отобранных в библиометрических базах данных Web of Science, Scopus и Google Scholar. Исследование основывалось на анализе научных статей за период 2019–2024 гг., поиск которых проводился по ключевым словам: «productivity loss» OR «absenteeism» OR «presenteeism» AND «economic evaluation». Изучено 58 зарубежных публикаций, релевантных сформулированной цели.

 Результаты. Проанализированы методы и подходы к оценке экономических потерь, связанные со снижением продуктивности рабочей силы в результате заболеваемости, в разрезе мер, которые направлены на сокращение временной нетрудоспособности, включающие мультидисциплинарные программы реабилитации, поведенческую терапию, программы по уменьшению стресса, образовательные сессии, консультирование, физические тренировки, многокомпонентные воздействия и т. п. Показано, что наиболее экономически эффективным типом вмешательства являются медицинские онлайн-консультации заболевших. Одновременно выявлено, что программы профилактики и лечения конкретных заболеваний эффективнее программ укрепления здоровья и вместе с тем сильнее снижают неявки на работу (absenteeism), чем повышают производительность труда работающих заболевших (presenteeism), экономический ущерб от которой значительно выше. Тем самым presenteeism является важнейшим недооцененным элементом, определяющим непрямые экономические потери, связанные с заболеваемостью рабочей силы.

 Заключение. Зарубежные исследования все чаще обращают внимание на проблему снижения производительности труда больных сотрудников, находящихся на рабочем месте. Потери от «переноса болезни на ногах» значительно превышают потери от отсутствия на рабочем месте, что требует разработки единых методов оценки и стратегий противодействия, которых на сегодня в России не существует. В условиях высокой закредитованности российского населения и его опасений потерять рабочие места игнорировать presenteeism недопустимо.

1. Davis K, Collins SR, Doty MM, Ho A, Holmgren A. Health and productivity among U.S. workers. Issue Brief (Com monw Fund). 2005;(856):1-10.

2. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290(18):2443-2454. doi: 10.1001/jama.290.18.2443

3. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398-412. doi: 10.1097/01.jom.0000121151.40413.bd

4. Reid MG. Economics of Household Production. New York: Wiley & Sons; 1934.

5. Mattke S, Balakrishnan A, Bergamo G, Newberry SJ. A review of methods to measure health-related productivity loss. Am J Manag Care. 2007;13(4):211-217.

6. Jones C, Verstappen SMM, Payne K. A systematic review of productivity in economic evaluations of workplace interventions: A need for reporting criteria? Appl Health Econ Health Policy. 2019;17(5):591-613. doi: 10.1007/s40258-019-00473-8

7. Gardner BT, Dale AM, Buckner-Petty S, Van Dillen L, Amick BC 3rd, Evanoff B. Comparison of employer productivity metrics to lost productivity estimated by commonly used questionnaires. J Occup Environ Med. 2016;58(2):170-177. doi: 10.1097/JOM.0000000000000587

8. Magnavita N, Meraglia I, Viti G, Borghese L. The work ability index (WAI) in the healthcare sector: A cross-sectional/retrospective assessment of the questionnaire. Int J Environ Res Public Health. 2024;21(3):349. doi: 10.3390/ijerph21030349

9. Lerner D, Amick BC 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D. The work limitations questionnaire. Med Care. 2001;39(1):72-85. doi: 10.1097/00005650-200101000-00009

10. Kessler RC, Barber C, Beck A, et al. The World Health Organization Health and Work Performance Questionnaire (HPQ). J Occup Environ Med. 2003;45(2):156-174. doi: 10.1097/01.jom.0000052967.43131.51

11. Work Productivity and Activity Impairment Questionnaire. Accessed June 5, 2025. https://repository.niddk.nih.gov/media/studies/mapp2sps/Forms/MAP-PII_WPAI_v2.0.20150306.pdf

12. iMTA. Treatment Inventory of Costs in Patients with psychiatric disorders. Accessed June 5, 2025. https://www.imta.nl/questionnaires/tic-p

13. Koopmanschap MA. PRODISQ: A modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharmacoecon Outcomes Res. 2005;5(1):23-28. doi: 10.1586/14737167.5.1.23

14. iMTA. Productivity Cost Questionnaire. Accessed June 5, 2025. https://www.imta.nl/questionnaires/ipcq/

15. Pokrzywinski RM, Soliman AM, Chen J, et al. Psychometric assessment of the health-related productivity questionnaire (HRPQ) among women with endometriosis. Expert Rev Pharmacoecon Outcomes Res. 2020;20(5):531-539. doi: 10.1080/14737167.2019.1662301

16. van Roijen L, Essink-Bot ML, Koopmanschap M, Bonsel G, Rutten FF. Labor and health status in economic evaluation of health care. The Health and Labor Questionnaire. Int J Technol Assess Health Care. 1996;12(3):405-415. doi: 10.1017/s0266462300009764

17. Shephard C, Hirst A, Buckland A, Vlachaki I, Wang-Silvanto J. Three methods for measuring productivity losses due to health related presenteeism in economic evaluations. Value Health. 2016;19(7):A364-A365. doi: 10.1016/j.jval.2016.09.107

18. Krol M, Papenburg J, Koopmanschap M, Brouwer W. Do productivity costs matter?: The impact of including productivity costs on the incremental costs of interventions targeted at depressive disorders. Pharmacoeconomics. 2011;29(7):601-619. doi: 10.2165/11539970-000000000-00000

19. Krol M, Papenburg J, Tan SS, Brouwer W, Hakkaart L. A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs. Eur J Health Econ. 2016;17(4):391-402. doi: 10.1007/s10198-015-0685-x

20. Capri S, Ceci A, Terranova L, Merlo F, Mantovani L, Members of the Italian Group for Pharmacoeconomic Studies. Guidelines for economic evaluations in Italy: Recommendations from the Italian Goup of Pharmacoeconomic Studies. Drug Inf J. 2001;35(1):189-201. doi: 10.1177/009286150103500122

21. Institute for Quality and Efficiency in Healthcare (IQWiG) [Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen]. General methods. Version 4.2 of 22 April 2015. Accessed June 5, 2025. https://www.iqwig.de/methoden/iqwig_general_methods_version_204-2.pdf

22. Norwegian Medicines Agency. PE Guidelines: Guidelines on how to conduct pharmacoeconomic analyses (March, 2012). Accessed June 5, 2025. https://www.ispor.org/heor-resources/more-heor-resources/pharmacoeconomic-guidelines/pe-guideline-detail/norway

23. Kostenhandleiding: Methodologie van Kostenonderzoek en Referentieprijzen voor Economische Evaluaties in de Gezondheidszorg. Institute for Medical Technology Assessment, Erasmus Universiteit Rotterdam, Rotterdam, the Netherlands; 2016. (In German.) Accessed June 5, 2025. https://pure.eur.nl/en/publications/bkosten-handleiding-bvoor-economische-evaluaties-in-de-gezondheids

24. Sivignon M, Eymere S, Vilery N, Tardu J. HTA287 impact of the 2020 update of the French Guidelines for Economic Evaluation on the Economic Opinions issued by the Economic Evaluation and Public Health Committee (CEESP). Value Health. 2023;26(12):S375-S376. doi: 10.1016/j.jval.2023.09.1970

25. Hubens K, Krol M, Coast J, et al. Measurement instruments of productivity loss of paid and unpaid work: A systematic review and assessment of suitability for health economic evaluations from a societal perspective. Value Health. 2021;24(11):1686-1699. doi: 10.1016/j.jval.2021.05.002

26. Mitchell RJ, Bates P. Measuring health-related productivity loss. Popul Health Manag. 2011;14(2):93-98. doi: 10.1089/pop.2010.0014

27. Public Health Agency of Canada. The Economic Burden of Illness in Canada, 2010. Accessed June 5, 2025. https://www.canada.ca/en/public-health/services/publications/science-research-data/economic-burden-illness-canada-2010.html

28. Yuasa A, Yonemoto N, LoPresti M, Ikeda S. Use of productivity loss/gain in cost-effectiveness analyses for drugs: A systematic review. Pharmacoeconomics. 2021;39(1):81-97. doi: 10.1007/s40273-020-00986-4

29. Yuasa A, Yonemoto N, LoPresti M, Ikeda S. Produc tivity loss/gain in cost-effectiveness analyses for vaccines: A systematic review. Expert Rev Pharmacoecon Outcomes Res. 2021;21(2):235-245. doi: 10.1080/14737167.2021.1881484

30. Gordois AL, Toth PP, Quek RG, Proudfoot EM, Paoli CJ, Gandra SR. Productivity losses associated with cardiovascular disease: A systematic review. Expert Rev Pharmacoecon Outcomes Res. 2016;16(6):759-769. doi: 10.1080/14737167.2016.1259571

31. Park H, Lee DW, Lee JH, Cho SS, Kim HR, Kang MY. The association between organizational justice and health-related productivity loss among Korean employees. J Occup Environ Med. 2022;64(5):377-381. doi: 10.1097/JOM.0000000000002489

32. Lu L, Chen Y. Association between suboptimal health status and health-related productivity loss in primary healthcare workers in China: A cross-sectional survey. Risk Manag Healthc Policy. 2024;17:1349-1359. doi: 10.2147/RMHP.S456058

33. Soliman AM, Anand SB, Coyne KS, Castelli-Haley J, Snabes M, Owens CD. Examining the relationship between symptomatic burden and self-reported productivity losses among patients with uterine fibroids in the United States. J Occup Environ Med. 2017;59(10):974-981. doi: 10.1097/JOM.0000000000001105

34. Soliman AM, Yang H, Du EX, Kelley C, Winkel C. The direct and indirect costs associated with endometriosis: A systematic literature review. Hum Reprod. 2016;31(4):712-722. doi: 10.1093/humrep/dev335

35. Pereira MJ, Johnston V, Straker LM, et al. An investigation of self-reported health-related productivity loss in office workers and associations with individual and work-related factors using an employer’s perspective. J Occup Environ Med. 2017;59(7):e138-e144. doi: 10.1097/JOM.0000000000001043

36. Brunner B, Igic I, Keller AC, Wieser S. Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work. Eur J Health Econ. 2019;20(8):1165-1180. doi: 10.1007/s10198-019-01084-9

37. Bouwmans CA, Vemer P, van Straten A, Tan SS, Hakkaart-van Roijen L. Health-related quality of life and productivity losses in patients with depression and anxiety disorders. J Occup Environ Med. 2014;56(4):420-424. doi: 10.1097/JOM.0000000000000112

38. Bialowolski P, McNeely E, VanderWeele TJ, Weziak-Bialowolska D. Ill health and distraction at work: Costs and drivers for productivity loss. PLoS One. 2020;15(3):e0230562. doi: 10.1371/journal.pone.0230562

39. Goettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: A systematic review of indirect costs. BMJ Open. 2017;7(10):e014632. doi: 10.1136/bmjopen-2016-014632

40. Song Z, Baicker K. Effect of a workplace wellness program on employee health and economic outcomes: A randomized clinical trial. JAMA. 2019;321(15):1491-1501. doi: 10.1001/jama.2019.3307

41. Song Z, Baicker K. Health and economic outcomes up to three years after a workplace wellness program: A randomized controlled trial. Health Aff (Millwood). 2021;40(6):951-960. doi: 10.1377/hlthaff.2020.01808

42. Bonatesta L, Palermi S, Sirico F, et al. Short-term economic evaluation of physical activity-based corporate health programs: A systematic review. J Occup Health. 2024;66(1):uiae002. doi: 10.1093/joccuh/uiae002

43. Bernaards CM, Bosmans JE, Hildebrandt VH, van Tulder MW, Heymans MW. The cost-effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on recovery from neck and upper limb symptoms and pain reduction in computer workers. Occup Environ Med. 2011;68(4):265-272. doi: 10.1136/oem.2008.045450

44. Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefits and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46. doi: 10.5271/sjweh.763

45. Baid D, Hayles E, Finkelstein EA. Return on investment of workplace wellness programs for chronic disease prevention: A systematic review. Am J Prev Med. 2021;61(2):256-266. doi: 10.1016/j.amepre.2021.02.002

46. Unsal N, Weaver G, Bray J, Bibeau D. A scoping review of economic evaluations of workplace wellness programs. Public Health Rep. 2021;136(6):671-684. doi: 10.1177/0033354920976557

47. Tingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: A systematic review and meta-analysis of randomized controlled trials. Syst Rev. 2022;11(1):192. doi: 10.1186/s13643-022-02055-7

48. Brouwers EP, de Bruijne MC, Terluin B, Tiemens BG, Verhaak PF. Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: A randomized controlled trial. Eur J Public Health. 2007;17(2):214-220. doi: 10.1093/eurpub/ckl099

49. Rebergen DS, Bruinvels DJ, Bezemer PD, van der Beek AJ, van Mechelen W. Guideline-based care of common mental disorders by occupational physicians (CO-OP study): A randomized controlled trial. J Occup Environ Med. 2009;51(3):305-312. doi: 10.1097/JOM.0b013e3181990d32

50. Verbeek JH, van der Weide WE, van Dijk FJ. Early occupational health management of patients with back pain – A randomized controlled trial. Spine (Phila Pa 1976). 2002;27(17):1844-1851. doi: 10.1097/00007632-200209010-00006

51. Viikari-Juntura E, Kausto J, Shiri R, et al. Return to work after early part-time sick leave due to musculoskeletal disorders: A randomized controlled trial. Scand J Work Environ Health. 2012;38(2):134-143. doi: 10.5271/sjweh.3258

52. Viikari-Juntura E, Leinonen T, Virta LJ, et al. Early part-time sick leave results in considerable savings in social security costs at national level: An analysis based on a quasi-experiment in Finland. Scand J Work Environ Health. 2019;45(2):203-208. doi: 10.5271/sjweh.3780

53. Uegaki K, Bakker I, de Bruijne M, et al. Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: Results of an economic evaluation alongside a pragmatic randomised control trial. J Affect Disord. 2010;120(1-3):177-187. doi: 10.1016/j.jad.2009.04.012

54. Hlobil H, Uegaki K, Staal JB, de Bruyne MC, Smid T, van Mechelen W. Substantial sick-leave costs savings due to a graded activity intervention for workers with non-specific sub-acute low back pain. Eur Spine J. 2007;16(7):919-924. doi: 10.1007/s00586-006-0283-9

55. Jensen C, Nielsen CV, Jensen OK, Petersen KD. Cost-effectiveness and cost-benefit analyses of a multidisciplinary intervention compared with a brief intervention to facilitate return to work in sick-listed patients with low back pain. Spine (Phila Pa 1976). 2013;38(13):1059-1067. doi: 10.1097/BRS.0b013e-31828ca0af

56. Lawrance N, Petrides G, Guerry AM. Predicting employee absenteeism for cost effective interventions. Decis Support Syst. 2021;147:113539. doi: 10.1016/j.dss.2021.113539

57. Tarro L, Llauradó E, Ulldemolins G, Hermoso P, Solà R. Effectiveness of workplace interventions for improving absenteeism, productivity, and work ability of employees: A systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2020;17(6):1901. doi: 10.3390/ijerph17061901

58. Schmidt B, Schneider M, Seeger P, van Vianen A, Loerbroks A, Herr RM. A comparison of job stress models: Associations with employee well-being, absenteeism, presenteeism, and resulting costs. J Occup Environ Med. 2019;61(7):535-544. doi: 10.1097/JOM.0000000000001582