200 Million Euro Theft: Fake Sick Leaves Among Švejk Soldiers, Catch-22 and Burnout

Rich old man Argan spends enormous amounts of money on doctors, who exploit his hypochondria. Unlike the titular character of Molière’s ‘The Imaginary Invalid’, Croatian ‘argans’ do not spend their own money on treatment, but rather someone else’s, namely public money, thus defrauding all taxpayers and employers. The scale of this theft is comparable to last year’s gas scandal in INA, which cost over a billion kuna.

Everyone Takes 13 Days of Sick Leave

All employees in Croatia spent over 21 million days on sick leave last year, which amounts to 57,534 years! This means that each of the one and a half million employees was – on average – on sick leave for 13 days. For comparison, a city the size of Pula and Lipik combined was in hospital beds or receiving home treatment for the entire year, meaning that all working-age residents of Šibenik-Knin County were out of work.

Last year, the state paid around 217 million euros for sick leaves (longer than 42 days). According to HUP’s estimates, the cost to companies for sick leaves (shorter than 42 days) was around 400 million euros. I was shocked by the data from HRT’s ‘Dnevnik’ that as much as 31 percent of sick leaves are – fake. Imaginary invalids cost the state 67 million euros last year, and employers another 124 million; in total, more than 190 million euros, or about a billion and a half kuna!

HZZO inspectors discovered 2,965 unjustified, or fake sick leaves in 9,532 checks in the first three months. Optimism should perhaps be instilled by the trend – in 2021, 35 percent of fake sick leaves were discovered, last year 33 percent, and now we have improved to ‘only’ 31 percent.

Sanctions for fake sick leaves should be borne by family medicine doctors, who issue the sick leaves, in the form of fines or revocation of their licenses. However, I do not recall (even with the help of newspaper archives and artificial intelligence) that any such sanctions have come to public attention. Despite this, family doctors occasionally dismiss accusations and claim they are not the producers of fake sick leaves. They also cite other reasons for excessive absences from work, such as prolonged assessments of work ability and excessively long waits for diagnostics, as many health conditions require extensive medical examinations and procedures.

Mental Disorders Are Threatening

On the other hand, blue envelopes in the healthcare system have become commonplace. Croatian healthcare ranks just behind politicians and officials, as well as police, customs, courts, and inspectors, on the corruption perception index. According to a Eurobarometer survey from a year ago, 45 percent of 996 respondents in Croatia believe that bribery and abuse of power for personal gain are widespread in healthcare. Besides for expedited examinations, surgical interventions, or hospitalizations, part of this perception also relates to bribery for issuing sick leaves.

In Croatia, the most common causes of death are diseases of the circulatory system, malignant tumors, diabetes, and COVID-19. Statistics will say that the most common illnesses are hypertension, chronic lung diseases, COVID-19, and diabetes, while the most common reasons for issuing sick leaves are COVID-19, injuries, and – mental disorders. While the first two cases are clear, such a high ranking of diagnosing mental disorders as a reason for issuing sick leaves raises suspicions.

Namely, these are diseases that are sometimes difficult to prove. Most of those who wanted to avoid military service before the former JNA cited such diagnoses. The simple soldier Švejk was declared crazy by the commission, yet he still ended up in World War I. Joseph Heller varied the same theme in his novel ‘Catch-22’. It refers to a ‘catch’ from World War II according to which a military doctor will only send home the insane, but anyone who is insane cannot request a return because that would mean they are actually healthy.

Why New Generations Are Burning Out

Croatian healthcare, hand in hand with modern global trends, seems to continue the tradition of Hašek and Heller. The new catch-22 is – burnout. According to the definition of the World Health Organization, it is the result of chronic workplace stress and manifests as a feeling of increased exhaustion, negativity, and reduced efficiency.

Once, those who had a lot of work would say ‘I work like crazy’, which was normal for young employees full of energy and ambition seeking their place in the corporate hierarchy. Today’s young generation is burning out. It will remain part of urban legend that one of the first texts on this topic in Croatia was written by a journalist who never burned out at work.

Joking aside, this is a problem that doctors also warn about: – Well-paid and motivated workers are less frequently and for shorter periods on sick leave. People who burn out at work, who are exhausted, whose compensatory resources are depleted, who lack the strength to work are increasingly in our offices – said family medicine doctor Dr. Milan Mazalin for HRT, urging employers with high sick leave rates to first analyze the situation in their own companies, as they will find the causes of many problems there, and if they improve the situation, perhaps sick leave rates will decrease.

There is quite a bit of truth in that. Today’s pace of life (and work) is significantly harsher than a few decades ago, and with the shortening of all cycles, the cycle of (expected) career advancement is also shorter. Therefore, burnout is more present today. Of course, burnout is neither the only problem (with sick leaves) nor can all companies turn workplaces into amusement parks. However, fake sick leaves would be a smaller problem if the state took greater responsibility.

Namely, all sick leaves up to 42 days are borne by employers, and they have no control instruments, which are in the hands of the state. The state has, however, given inspectors greater powers, so they can now terminate fake sick leaves themselves. They also have the option to conduct home inspections, but, as far as I know, no one has used that yet. Perhaps that is why the share of fake sick leaves is ‘only’ 31 percent.