Salut defends incentives for primary care centers to prevent sick leave from being "unnecessarily prolonged".

BarcelonaThe Department of Health has come out to defend its proposal Provide incentives to CAPs to shorten the duration of sick leaveA measure that has stirred controversy in recent hours. This Monday, the Catalan Health Department (Salut) stated in a press release that the proposal to improve the management of temporary disability (TD) does not aim to "reduce the number or duration of sick leave, but rather to prevent it from being unnecessarily prolonged due to organizational problems, delays in testing, or difficulties accessing specialists." Salut thus justifies its decision to promote financial incentives in Catalan healthcare centers to shorten the duration of sick leave for mental health issues and musculoskeletal injuries. However, some within the sector are calling this argument "purely economic."

"The main objective is to guarantee that sick leave lasts only as long as it is truly needed: nothing less," argue sources from the Health Department. "When sick leave is prolonged without a clear clinical reason, it causes suffering to the worker, delays their recovery, and also places an overload on the system," they add. The regional health ministry, led by Olga Pané, maintains that this measure aims to "strengthen primary care, expedite diagnoses, facilitate access to tests, and improve coordination between services, so that patients can receive faster and more effective care."

Specifically, the Catalan government (Generalitat) indicates that priority has been given to changes in the treatment of musculoskeletal conditions, considering that these can be referred to private health insurance companies to improve waiting times, and mental health problems because they account for the most sick leave days in Catalonia. "These are very common problems among the working population and, if not addressed in time, have a high risk of becoming chronic," the department emphasizes. They cite as an example situations where, after 45 days of sick leave, there are still pending tests or treatments that have not yet begun. In these cases, they say, the case will be reviewed to find alternatives and prevent the situation from being unnecessarily prolonged. In other words, "to intervene before the problem becomes chronic," the department stresses. The FoCAP (Catalan Federation of Primary Care Physicians) says it questions doctors.

According to a report presented by the employers' association Pimec to illustrate absenteeism at work,one of the major current concerns of the business communityFrom 2013 to 2025, sick leave has more than doubled, and of these, those due to mental health reasons have almost tripled, specifically between 2015 and 2024. A week ago, Minister Pané stated in Parliament that Catalonia is the second autonomous community in terms of sick leave, with 15% of the population over 24 years of age. "The lowest number of sick leaves corresponds to people over 55 years old; therefore, you will understand that as Minister, I am concerned about the health of our citizens. If these figures are accurate, we have a very serious health problem," she added.

The Catalan Primary Care Forum (FoCAP) asserts that this new measure "undermines public trust" in primary care providers, violates workers' rights, and complicates the already difficult assessment of sick leave duration. For these reasons, they demand the withdrawal of these financial incentives. According to the organization, the Catalan Health Service (CatSalut) will financially penalize teams where sick leave due to musculoskeletal or mental health issues extends beyond its expected duration, which could further widen the gap between regions, disproportionately affecting areas with fewer resources. In this regard, FoCAP emphasizes that sick leave is a therapeutic tool, like prescribing medication, but that the coding of illnesses and patients' occupations makes calculating the optimal duration difficult. They also lament that "approximately 75% of occupational diseases are not recognized," but that the compensation agreement points to doctors and users as responsible for the increase in the number and duration of sick leave, "avoiding the real causes," such as the worsening health of workers and the lack of recognition of work-related illnesses.

This independent, non-profit organization warns that these indicators generate a risk of demotivation among primary care physicians. "The measure implies distrust in professional judgment and introduces more economic factors into consultations," they state. They also emphasize that primary care is blamed for not conducting medical inspections to monitor sick leave and is criticized for the system's slow treatment or rehabilitation of patients. "No social causes are mentioned for this phenomenon, such as aging and the increase in chronic diseases, job insecurity, and the type of employment and its risks, both ergonomic—which affect half of all workers—and psychosocial: up to 40% of workers cite work as a cause of stress."

How incentives work

The incentive mechanism proposed by the department is based on primary care centers (CAPs) receiving increased funding if they avoid undiagnosed sick leave and delays in visits to assess individuals temporarily unable to work due to health issues, and, if they have recovered, to discharge them. These bonuses will not affect the base budget each center receives for its regular operations, but they will determine whether or not it receives additional funding. "This is not about further incentivizing doctors or nurses to reduce the duration of care, but rather about implementing measures to align the duration with the clinical reality of the process," the department stated. The government also affirms that "the objective is to empower teams so they can better care for patients and resolve cases more quickly, and to incentivize them to review processes and implement effective management." The resources will be allocated to healthcare teams and centers to improve their processes, such as streamlining procedures, expediting tests, enhancing coordination, implementing monitoring tools, and strengthening specific mechanisms that promote good management.

What are the next steps

The Department of Health has indicated that the proposal falls within the framework of the agreement signed with the National Social Security Institute (INSS) for the period 2025-2028, which regulates how sick leave is managed and monitored in Catalonia. "The agreement's ultimate goal is to improve management, not to shorten durations," sources from the department emphasized. In this regard, they noted that this agreement establishes mechanisms to detect "when sick leave lasts longer than would be expected from a clinical perspective and to activate support measures." With this objective, targets are set each year so that healthcare centers can improve the management of these processes. As the department explained, this proposal was developed by the Primary Care management teams, in consensus with the Ministry of Health. Therefore, several steps remain: final validation by the relevant bodies, agreement with the various stakeholders, definition of the specific action plans, and integration of the objectives into the monitoring system. Finally, Salut maintains that, once this process is complete, the measure will be implemented with evaluation mechanisms to verify its results.