Beyond health care spending : drivers of health-related production losses in Switzerland

Background: Production losses caused by temporary or permanent reductions in working capacity constitute a substantial economic impact of poor health. However, they are rarely analyzed beyond isolated cost-of-illness studies. While most countries systematically monitor health care spending, there is no equivalent framework for measuring production losses. Consequently, the magnitude of these costs, their different forms—such as absenteeism, presenteeism, disability, and premature death—and their distribution across diseases, age and sex remain unclear. This study aims to quantify total production losses in Switzerland using a human capital approach for the years 2012, 2017, and 2022, examining the trends in their different forms and identifying the diseases driving these losses. Methods: Our analysis followed a two-step approach: First, we calculated the total production losses by their different forms and aggregated them into their yearly totals. Second, we decomposed these losses by disease, age, and sex. We drew on multiple data sources, including national statistics on work volume, income, and causes of death, the Swiss Labor Force Survey, and a workforce panel survey covering working conditions, health issues, and the Work Productivity and Activity Impairment Questionnaire. Additionally, we accessed detailed data from the national disability insurance scheme. The data on production losses due to premature death and disability included diagnostic information, allowing clear attribution of these losses to specific diseases. In contrast, data for absenteeism and presenteeism were limited, covering only a selected subset of major diseases. To address this limitation, we applied a stepwise regression analysis, first attributing losses to uncoded diseases and then allocating the remaining losses to coded diseases. Results (preliminary): Production losses amounted to 70.7 billion Swiss Francs (CHF, 1 CHF ≈ 1 USD in 2022), equivalent to 9% of Switzerland’s GDP in 2022, representing a 15% increase compared to 2012. In 2022, presenteeism accounted for the largest share of production losses (48%), followed by absenteeism (26%), disability (18%), and premature death (8%). Musculoskeletal disorders (16%), mental disorders (15%), injuries (15%), and cardiovascular diseases (10%) were the leading causes of absenteeism, while 26% of absenteeism-related losses were attributed to uncoded diseases. Across all forms of production losses, mental disorders had the greatest impact, contributing 18% of total losses, with younger age groups being particularly affected. Conclusions: In 2022, total production losses in Switzerland were only slightly lower than total health care spending (91.5 billion CHF). Combined, these costs represented over 20% of the country’s GDP. Among the working-age population, production losses substantially exceeded health care expenditures. Production losses were primarily driven by high prevalence and often chronic conditions such as musculoskeletal and mental disorders. As labor shortages intensify and the population ages, understanding the factors contributing to various forms of production losses becomes increasingly vital. This knowledge is essential for developing effective policies to address their growing social and economic burden.