Salut argues that the incentives in the CAPs are to prevent sick leave from being "unnecessarily prolonged".

BarcelonaThe Department of Health has come out in defense of the proposal Provide incentives to CAPs to shorten the duration of sick leavewhich has stirred up controversy in recent hours. This Monday, the Catalan Health Department (Salut) asserted 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 justifies the new measure, which proposes implementing financial incentives in Catalan healthcare centers if they manage to prevent excessively long periods of sick leave for mental health reasons and musculoskeletal injuries.

"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 the new 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."

Regarding the selected illnesses, the Catalan government points out that priority has been given to musculoskeletal conditions—which can be referred to private health insurance companies to reduce waiting times—and mental health problems because these account for the most sick leave days in Catalonia. "These are very common problems among the working population, and if they are not addressed promptly, they have a high risk of becoming chronic. When, after 45 days, there are still pending tests or treatments that have not yet begun, the case is reviewed to find alternatives and prevent the situation from being unnecessarily prolonged. The goal is to intervene before the problem becomes chronic."

FoCAP warns that "it undermines social trust"

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 its withdrawal. According to this 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, the organization emphasizes that sick leave is a therapeutic tool, like medication, but that the coding of illnesses and patients' occupations makes calculating the optimal duration difficult. The FoCAP (Focused Primary Care Physicians' Association) also laments that approximately 75% of occupational illnesses are not recognized, but that the compensation agreement points to doctors and patients as responsible for the increase in the number and duration of temporary disabilities, "avoiding the real causes," such as the deterioration of workers' health and the lack of recognition. 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 and 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 patients on leave 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. "The aim is not to further incentivize doctors or nurses to reduce the duration of illness, but rather to implement 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 practices."

It is planned that economic resources will be allocated to healthcare teams and centers so they can improve their processes, such as strengthening workflows, expediting testing, improving coordination, implementing monitoring tools, or reinforcing certain 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.