IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

The Economics of Presenteeism: A discrete choice & count model framework

Listed author(s):
Registered author(s):

    There are three levels in this paper: A search for economic theories about presenteeism, a search for appropriate econometric approaches, and finally empirical results based on a unique Danish cross sectional data set. There are two economic approaches to presenteeism: 1. Productivity losses and 2. labor supply. The first is part of the indirect cost component in cost-of-illness studies and economic evaluation. There are two core questions in the productivity loss literature: Measurement of productivity losses (‘how much’) which has dominated the research agenda and valuation of incurred productivity losses (monetary value). Few economists have addressed the valuation issue and point out that the wage rate sometimes is inadequate. The starting point in the labor supply literature is sickness absence coupled with labor demand. The few economic models about presenteeism are explored and found lacking in the sense that they do not capture the essence of presenteeism. However, discrete choice models (random utility models) seem to be adequate in that the choice about going sick to work basically is a discrete choice situation that can be extended to include discrete counts, i.e. episodes of presenteeism within a given time period. The econometrics of presenteeism must have count models as the starting point due to the many zeroes, i.e. many persons do not experience presenteeism and, if they do, usually relatively few days (‘events’) in a given period and the discrete choice nature of presenteeism. Drawing on the econometric literature on utilization of medical services, the following models are discussed briefly: Poisson models, negative binominal, zero-inflated negative binomial, two part models (hurdle models) and latent class models (finite mixture models). This is in contrast to almost all previous literature where logistic regression has been the dominant statistical strategy. The Poissson model is discarded because an important feature (mean – variance) does not hold. The other models are all used in the empirical part of the paper, and an attempt at model selection is made. The empirical analyses are based on a cross-section survey of Danes in the labor force, N=4,060. The survey was designed with presenteeism in mind – one of the few available data sets at present. Ideally, theory/models should guide empirical work, but can do so only if fully specified theories are available and this is not the case for the random utility models that do no provide much guidance on relevant explanatory variables. The explanatory variables therefore are selected from the existing empirical works along with a number of new variables used in the survey, e.g. attitudinal variables about presenteeism and sickness absence and questions about work environment. A consistent result across all analyses is – not surprisingly - the importance of self reported health status: The worse health situation, the more presenteeism. . Another consistent result is that sickness absence and presenteeism are positively correlated. Persons with managerial positions also consistently have more presenteeism Age and genders are also (almost) consistently statistically significant. Fear of unemployment is also consistently and significantly related to presenteeism.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL:
    Download Restriction: no

    Paper provided by COHERE - Centre of Health Economics Research, University of Southern Denmark in its series COHERE Working Paper with number 2014:2.

    in new window

    Length: 27 pages
    Date of creation: 15 Feb 2014
    Handle: RePEc:hhs:sduhec:2014_002
    Contact details of provider: Postal:
    COHERE - Center for Sundhedsøkonomisk Forskning, Institut for Virksomhedsledelse og Økonomi, Syddansk Universitet, Campusvej 55, DK-5230 Odense M, Denmark

    Phone: (+45) 6550 3081
    Fax: (+45) 6550 3880
    Web page:

    More information through EDIRC

    No references listed on IDEAS
    You can help add them by filling out this form.

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:hhs:sduhec:2014_002. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Terkel Christiansen)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.