Women Under 40 Dominate Medical Leave Cases in Spain, Highlighting Systemic Social Security Challenges

According to a recent report by Spain's Independent Authority for Fiscal Responsibility (Airef), the management of medical leaves within the Social Security system suffers from significant structural deficiencies. In 2024, the total cost of medical leaves reached a staggering €16.5 billion, making it the second-largest expenditure after pensions.

That year saw 8.59 million cases of temporary incapacity related to common illnesses, alongside 740,000 cases tied to professional risks. Women under 40 years old were identified as the most affected demographic, particularly those facing infectious, mental health, and respiratory issues. The report highlighted that medical leaves averaged 45.93 days, with mental health-related leaves lasting much longer, averaging nearly 98.5 days.

Salaried employees had a much higher incidence rate (38.3 cases per 1,000 workers) compared to freelancers (10.7 cases), though freelancers' leaves tended to last longer, increasing from 82 days in 2017 to over 100 days in 2024. Notably, the incidence of repeat medical leaves rose from 23% in 2017 to 31.8% in 2024, and workers with previous leaves are 250% more likely to have additional periods of incapacity.

Certain sectors like healthcare and social services recorded the highest incidence rates, with regional disparities evident—Navarra, Catalonia, and the Basque Country experienced the most cases. The payment structure for medical leave starts with no payment during the first three days, with employers paying from days 4 to 15, and thereafter the state taking over.

Airef's report underscores concerns over the cyclical nature of medical leaves, increasing during economic growth periods and receding during downturns, revealing both systemic and socioeconomic factors influencing medical leave trends in Spain over the past seven years.