Supporting the labour market reintegration of people on temporary incapacity benefits in Spain

Sickness absence rates have been continuously and significantly increasing in Spain in recent years. The incidence of sick leave in Spain almost doubled between 2013 and 2023, from 217.2 to 421.2 sick leave spells annually for every 1000 workers. This is concerning not only for health and labour market outcomes but also for Spain’s finances: public spending on temporary incapacity benefits doubled between 2013 and 2023. The Spanish government is exploring measures to tackle these challenges including strengthening the collaboration with mutual benefit societies to provide health services when the public system is saturated and allowing a gradual return to work from sick leave. The Spanish authorities requested technical support with the implementation of these measures and with exploring other mechanisms to support workers’ timely return to work. 

Starting in August 2025 and for a period of 22 months, the OECD, in cooperation with SG REFORM, is working with the Spanish authorities to analyse and implement measures to support return to work from sick leave, as well as to monitor and quantify the effects of sick leave policies going forward. This includes developing a set of recommendations based on an analysis of the Spanish situation and best practices from other countries. It also includes two study visits: to Austria, to examine lessons from the country’s implementation of a gradual return to work scheme, and to Belgium, to explore return-to-work measures and the potential role mutual benefit societies can play.

In the short to medium term, the project aims to provide a set of recommendations to revise the policy framework for temporary incapacity to support the labour market reintegration of people on sick leave. It will also develop a monitoring and evaluation framework to support the implementation and assess the impact of new policies in the field of temporary incapacity. In the long term, the project aims to halt the increase in temporary incapacity and, eventually, reduce sick leave prevalence and duration, thereby contributing to improving workers’ health and to reducing the pressures on public finances in Spain.

This type of support could be relevant for other countries looking to strengthen early intervention and develop effective return-to-work measures for workers on sick leave. Developing a strong early intervention framework with responsibilities and incentives for all stakeholders is an important lever to prevent workers with health conditions from leaving the labour market, for example through the disability system. Developing an effective early intervention system requires careful consideration of a country’s institutional context and the engagement of the many relevant stakeholders.