Not one day more, not one day less: the reality of sick leaves in Spain

The benefit of temporary disability (TD) has become a focus of controversy in the recent public debate on the social protection system in Spain, the. Often, alarmist discourses point to an unsustainable growth in spending and suggest an abusive use of sick leave. However, the report "Not one day less", prepared by the Trade Union Confederation of CCOO in March 2026, offers a rigorous analysis that debunks myths and places the health of working people as the central axis of the issue.

First, because the IT benefit is not a gratuitous concession, but a mechanism regulated by the General Social Security Law to protect two constitutional rights: the right to health and the right to work. Its objective is to guarantee economic protection while the worker receives healthcare until they can rejoin in optimal conditions. The guiding principle must be "not one day more, not one day less" than the essential time for healing.

The nominal spending on temporary disability has tripled in the last two decades

That said, it is undeniable that nominal IT spending has tripled in the last two decades, but this increase must be contextualized. Two-thirds of this increase are explained by strictly objective factors unrelated to any type of fraud. Firstly, the evolution of economic activity, the increase in the protected population (which has grown from 19.7 to 22.2 million people between 2007 and 2024) and the improvement in wages explain almost 48% of the spending growth. Secondly, the progressive aging of the working population contributes another 18.5%. Older workers present pathologies that require longer recovery periods and have higher contribution bases, which increases the cost per process.

But faced with the theses that point to a fraudulent use of sick leave, the report provides data that contradict these ideas. For example, the "hoax" has spread that sick leaves are abnormally concentrated on Mondays. The administrative reality is that ailments occurring during the weekend are massively registered on Monday as primary care doctors do not hold consultations on Saturday or Sunday.

When analyzing the average from Saturday to Monday, the percentage of sick leave (11.5%) is even lower than that of the rest of the days of the week. Furthermore, the growth in incidence is mainly concentrated in very short-term processes (less than 3 days) caused by minor ailments such as flu or respiratory infections, which do not generate any public expense.

The Covid-19 pandemic marked a turning point  for the increase in social awareness and sensitivity to health problems

CCOO denounces that reports from organizations like the AIReF omit the most important variable: the real health of the population. The Covid-19 pandemic marked a turning point, not only because of the disease itself, but because of the increase in social awareness and sensitivity to health problems.

Two areas stand out for their impact on IT: mental health, because mental and behavioral disorders have grown exponentially. Spain leads the world consumption of benzodiazepines, which reflects a first-order public health problem.

These processes last, on average, more than double that of the rest of the diagnoses (112 days compared to the general average of 45). Along with mental health, musculoskeletal diseases: Continue to be the main cause of sick leave of more than 15 days. The insufficiency of diagnostic and rehabilitation resources in the National Health System (SNS) causes curable processes to be unnecessarily prolonged by waiting lists.

Our report is critical and points out from CCOO the historical "under-budgeting" of healthcare in Spain. Public health spending is significantly lower than that of countries with more advanced economies in the EU (with differentials of up to 3 points of GDP). This insufficiency of preventive and care resources directly impacts the duration of sick leaves.

Likewise, point out that the control of the benefit is not objectionable. The work of medical professionals in primary or specialized care, together with that of the inspection of public health services, or the medical inspection of the Social Security, together with the work already carried out by the Mutuas in relation to professional contingencies, which are their responsibility, but also on common contingencies where they can make a proposal for discharge, are sufficient resources. 

But the key to this matter is that this control must be public, it should not be in the hands of institutions that present evident conflicts of interest. It is worth remembering that the Medical Inspection of the INSS has lost almost 18% of its staff since 2009, while affiliation grew by five million people. For optimal functioning, the staff of medical inspectors should be increased by at least 63%.

Public debate must be rigorous and serious, and CCOO proposes complementing the focus on administrative management and placing it on health outcomes to efficiently reduce spending. Among the key measures, the strengthening of the Public Health System stands out, especially in primary care and mental health services; facilitating family doctors detecting the professional origin of ailments to avoid the underreporting of occupational diseases (especially occupational cancer); that there be a presumption of occupational origin in musculoskeletal pathologies related to work; promoting the use of the resources of the Mutuas to advance diagnostic tests and treatments in traumatological pathologies detected by the SNS, but always under public control; integrating the mutuas as managing entities of Social Security to ensure that their actions are governed exclusively by the general interest and not by other criteria derived from their current configuration as employers' associations.

In conclusion, the evolution of temporary disability in Spain is a thermometer of the state of health of our society and of the strength of our public services. The solution is not to cut rights or criminalize the sick worker, but to invest in a healthcare system capable of healing faster and better, when this is possible.