Home Visits During Sick Leave
Introduction
Boeri, di Porto, Naticchioni, and Scrutinio (2022) estimate the MVPF of home visits by general practitioners to Italian public sector employees on sick leave. Over a period of 45 days (29 working days) between November 2017 and January 2018, the Italian social security administration (INPS) randomly selected public employees on sick leave to receive a home visit by a general practitioner. During the sample period, about 4,200 individuals on sick leave received a home visit. The comparable control group was comprised of about 38,000 individuals. The paper finds that the amount of time spent on sick leave during the 16 months following and including the study period was, on average, six days lower for individuals who received a home visit. The effect captures both intensive margins–how long any particular sick period lasted–and the extensive margin–how often the individual took started a new period of sick leave. The effect was stronger for individuals who were not at home when the doctor visited, or was considered fit to work by the doctor. The effect was stronger for individuals who were not at home when the doctor visited or who were considered fit to work by the doctor.
MVPF = 1.1
Net Cost
As discussed above, spending an additional Euro on HVs involves a reduction of 9 Euros of expenditure on sickness benefits. Hence, the net government saving is 8 Euros per Euro spent.
The paper estimates that the cost of a single home visit ranges between 25 and 50 Euro. They assume the largest end of that range to estimate an upper bound. Under that assumption, the 4,200 home visits performed over the course of the sample period cost 50 * 4,200 = 210,000 Euros.
The paper then uses their baseline estimate that an unexpected home visit reduces the total amount of sick leave taken by 5.5 days to determine the reduction in costs to the government as a result of the home visit. Workers are paid, on average, 81.5 Euros per day and the replacement rate for the first 9 months of leave is 100% of the wage rate. This suggests that a home visit saves 5.5 * 81.5 = 448.3 Euros of wage replacement per home visit for a total savings of 448.3 * 4,200 = 1,882,650 Euros. The net cost, therefore was 1,672,650 Euros. Per Euro spent, this works out to be 8.965 Euros saved for a scaled net cost of -7.965.
The paper notes that this is likely an underestimate of the total potential savings as the individuals to audit were chosen randomly rather than those who were most likely to be deemed fit to work.
Willingness to Pay
The paper estimates an upper bound on the audited individuals’ willingness-to-pay to avoid the home visit by assuming that individuals would be wililng to pay up to the entirety of their lost benefits of -8.965 Euros per Euro spent on home visits.
The paper notes that they estimate essentially no implicit wage reduction or other sanction for receiving a home visit.
MVPF Summary
The estimated MVPF then is -8.965/-7.965 = 1.13.
References
Tito Boeri, Edoardo di Porto, Paolo Naticchioni, and Vencenzo Scrutinio. “Friday Morning Fever. Evidence from a Randomized Experiment on Sick Leave Monitoring in the Public Sector.” Working Paper IZA DP No. 14346 (2022). https://www.econstor.eu/bitstream/10419/236377/1/dp14346.pdf
Policy Features
- Category
- Social Insurance
- Beneficiary Type(s)
- Adults
- Average Age
- 53
- Country of Implementation
- Italy
- Empirical Method
- RCT
- Research Type
- Primary
- Peer Reviewed
- No
- MVPF Publication Link
- www.econstor.eu/bitstream/10419/236377/1/dp14346.pdf