250 € vs. 500–1500 €

According to data from the German Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin), the average gross cost of sick leave is about €249 per employee per day (Germany, 2023). This cost includes lost productivity, organisational disruption and additional pressure on employers.

However, there is another problem that is often larger and less visible: presenteeism.

Coming to work while ill, or while dealing with serious personal concerns such as family problems, can have a greater financial impact than sick leave itself. The reason is simple: the employee is physically present but works more slowly, makes more mistakes and may make poorer decisions.

Some analyses estimate that productivity losses caused by presenteeism can be 2 to 6 times higher than the cost of absenteeism, depending on the sector and the country.

A term many people do not know

Interestingly, presenteeism as a phenomenon is widespread, but the term itself is relatively unknown.

Google Trends shows that burnout is a dominant public term, while absenteeism and especially presenteeism remain largely specialist terms with much lower interest in general online searches.

A very rough estimate of their relative visibility:

term                       approximate relative visibility
burnout                 100
absenteeism       ~10–20
presenteeism      ~1–3

In other words, the public speaks much more frequently about burnout than about presenteeism, even though the organisational consequences can be equally significant.

The term presenteeism was introduced as early as 1955, but for decades it remained largely confined to professional literature.

The phenomenon itself is widespread. In some studies around 53% of employees report that they have come to work while ill more than once.

Five types of presenteeism

Presenteeism is not a single behaviour. In practice it appears in several different forms.

1. health-related presenteeism

Coming to work despite illness or a physical health problem.

Typical examples:

• working with flu or infection
• working with chronic pain
• working under medication

2. mental-health presenteeism

Coming to work despite psychological exhaustion or mental health difficulties.

Examples:

• burnout
• depression
• severe stress or emotional exhaustion

3. normative presenteeism

Coming to work because of organisational culture or expectations from colleagues and managers.

Examples:

• “good employees do not take sick leave”
• pressure from colleagues or supervisors
• the need to demonstrate loyalty

4. structural presenteeism

Coming to work because the organisation has no mechanisms that allow absence.

Examples:

• no replacement available
• very small teams
• projects with tight deadlines

5. job-security presenteeism

Coming to work because of fear of negative consequences.

Examples:

• fear of losing the job
• fear of poor performance evaluation
• insecure contracts

Differences between sectors

Research shows that the level of presenteeism varies significantly across sectors.

1. healthcare – the highest levels of presenteeism

Studies show that the healthcare sector is among the most affected.

• among nurses, research reports 32% to 94% of employees working despite illness
• in some studies around 40% of healthcare workers come to work even when they are sick

Typical reasons include:

• moral responsibility towards patients
• staff shortages
• strong professional duty
• difficulty replacing staff during shifts

2. public administration

Presenteeism is also relatively common in the public sector, but for somewhat different reasons.

Typical patterns include:

• organisational cultures emphasising reliability and responsibility
• long administrative processes and obligations
• higher levels of mental stress

Main drivers include:

• responsibility toward public service
• administrative pressure
• slower replacement processes for staff

3. IT sector

In IT, a specific form known as digital presenteeism often appears.

Typical patterns include:

• working while ill because remote work is possible
• working evenings or weekends
• constant online availability

In this sector there is less physical presenteeism, but more:

• mental-health presenteeism
• working during illness or exhaustion.

4. manufacturing and industry

Industry shows a different pattern.

Typical characteristics include:

• physically demanding work
• fewer possibilities for remote work
• strict production deadlines

As a result, presenteeism often appears as:

• working with pain or minor injuries
• working under medication
• coming to work due to fear of losing shifts or income

Conclusion

Sick leave is a visible cost.
Presenteeism is a hidden cost.

While organisations can relatively easily track employee absences, productivity loss among employees who work despite illness or exhaustion is much harder to detect and measure.

For that reason, presenteeism often remains invisible – even though its impact on organisations can be greater than the cost of sick leave itself.

 

Marijan Gjukić