Annals of Occupational and Environmental Medicine

Opinion

A sickness benefit for all, leaving no one behind: Daseul Moon, Hongjo Choi; Ann Occup Environ Med 2025;37:e25. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e25

Abstract Abstract in Korean PDF: South Korea’s pilot sickness benefit program, launched in 2022 across six regions and currently operating in 14 regions as of 2025, represents a critical juncture in the country’s social protection development. While ostensibly designed with inclusive eligibility criteria, the program reveals fundamental paradoxes that illuminate deeper structural inequalities within Korea's dualized labor market. This opinion piece examines how current design choices risk undermining universal health coverage goals by systematically excluding the most precarious workers. The program’s design features—including low replacement rates (60% of the minimum wage) and extended waiting periods—created perverse incentives where the most vulnerable workers accepted the least favorable conditions. This pattern exemplifies what Korpi and Palme termed the “paradox of redistribution,” where targeted approaches ultimately prove less effective than universal ones, with the second phase’s restriction to the bottom 50% income bracket threatening to exacerbate this paradox. Successful implementation will depend on integrating equity, people-centered design, and gender-transformative perspectives into every phase—design, operation, evaluation, and reform. In doing so, South Korea has the opportunity to offer a model of sickness protection that does not simply patch gaps, but actively reshapes the structures that produce health and economic inequalities in the first place.; 모두를 위한 상병수당의 과제
2022년 6개 지역에서 시작되어 2025년 현재 14개 지역에서 시행되고 있는 한국형 상병수당 시범사업은 한국 사회보장의 제도적 발전에 있어 중요한 전환점을 나타낸다. 시범사업은 기존 제도와 비교해 보다 포용적인 자격 기준으로 설계되었지만, 한국의 이중화된 노동시장과 결합한 구조적 불평등을 드러내는 근본적 역설들을 보여주고 있다. 본 논문은 현재의 제도적 설계가 한국의 불안정한 노동자들을 체계적으로 배제하며, 이것이 보편적 건강보장 목표 달성에 장벽으로 작동한다는 점을 분석한다. 1차 시범사업 신청 현황 분석 결과, 낮은 소득대체율(최저임금의 60%)과 긴 대기기간을 포함한 프로그램의 설계 특징들은 가장 취약한 노동자들이 가장 불리한 조건을 받아들이는 역설적 유인을 만들어냈다. 이러한 패턴은 재분배의 역설을 반영하며, 2단계에서 소득 하위 50%로 대상을 제한한 것은 이러한 역설을 심화할 것으로 예상된다. 상병수당 제도의 성공적인 실행은 설계, 운영, 평가, 개혁의 모든 단계에서 형평성, 사람 중심 설계, 젠더 변혁적 관점을 통합하는 데 달려 있다. 이를 통해 건강과 경제적 불평등을 생산하는 구조를 재편하는 제도로서 상병수당을 기대할 수 있을 것이다.

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Review

Medical certification in sickness benefit schemes (I): theoretical perspectives and return-to-work: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;37:e23. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e23

Abstract Abstract in Korean PDF Supplementary Material

This study explores the theoretical foundations and practical applications of medical certification within the sickness benefit systems, particularly in the context of Korea’s pilot program and its planned national rollout. While sickness benefit systems have long existed in many Organization for Economic Cooperation and Development (OECD) countries, Korea has only recently initiated pilot projects, largely prompted by the coronavirus disease 2019 pandemic. These systems aim to compensate for income loss due to illness or injury, and medical certification plays a central role in determining eligibility and work ability. This study defines medical certification as a two-stage process: clinical diagnosis and formal assessment of a worker’s ability to return-to-work. The dual nature highlights the distinct objectives of the medical treatment and social security policies. Drawing on international practices, this study reviews the International Classification of Functioning, Disability, and Health (ICF) as a key global framework for assessing disability and work ability, although it acknowledges the limitations of its application to sickness benefits. The research emphasizes a shift in global trends toward return-to-work–oriented certification models, such as the UK’s “fit note” system, which focuses on evaluating fitness-for-work rather than merely documenting illness. Sweden and Japan also offer models that integrate rehabilitation with flexible work accommodations. Three key issues were identified in Korea’s system: the role of medical certification and concerns about moral hazard, the burden of proof and workload on physicians, and public perceptions of the program’s purpose. We believe that medical certification should not only verify illness but also support early intervention and a healthy workforce. Ultimately, this study advocates for a balanced and efficient medical certification system tailored to Korea’s healthcare context closely aligning with labor market policies to ensure long-term sustenance and integration of the sickness benefit program.

상병수당 제도에서의 의료인증체계(1): 이론적 배경과 직장복귀
본 연구는 한국의 시범사업과 향후 전국적 시행을 앞둔 상황에서 상병수당 제도에서 의료인증의 이론적 기반과 실제적 적용을 살펴보고자 하였다. 상병수당 제도는 많은 OECD 국가에서 오래전부터 시행되어 왔으나, 한국에서는 COVID-19 팬데믹을 계기로 최근에야 시범사업이 시작되었다. 이 제도는 질병이나 부상으로 인한 소득 상실을 보상하는 것을 목적으로 하며, 의료증명은 수급 자격 및 업무 수행 능력을 판단하는 핵심적 요소이다.
의료인증은 진단이라는 1단계와, 업무복귀 가능성을 공식적으로 평가하는 2단계로 구성되며, 이는 의료적 목적과 사회보장 정책 목적의 차이를 드러낸다. 국제적 관행을 참고하여, 본 연구는 장애 및 업무능력 평가의 세계적 기준인 ‘기능장애건강국제분류(ICF)’를 검토하되, 이를 상병수당에 적용하는 데 있어 한계점도 지적한다. 연구는 세계적으로 ‘복귀 중심(return-to-work)’ 의료증명 체계로의 전환이 이루어지고 있음을 강조한다. 예를 들어, 영국의 ‘핏 노트(fit note)’ 제도는 단순한 질병 증명에서 벗어나 업무수행 가능성을 평가하는 방식이다. 스웨덴과 일본은 재활과 유연한 업무조정을 포함한 모델을 운영 중이다.
한국 제도 설계에서 중요한 세 가지 이슈는 의료인증의 역할과 도덕적 해이 우려, 의료진의 입증 책임 및 행정 부담, 그리고 제도 목적에 대한 대중의 오해이다. 본 연구는 의료적 증명이 단순한 질병 확인을 넘어 조기 개입과 건강한 노동력 유지로 이어져야 한다고 주장한다.
궁극적으로 본 연구는 한국의 의료이용 환경에 적합하고 노동시장 정책과 조화를 이루는, 균형 있고 효율적인 의료증명 체계의 구축을 제안한다. 이는 상병수당 제도의 지속 가능성과 신뢰성을 확보하는 데 핵심적인 요소다.

Citations

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Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability
Yangwoo Kim, Inah Kim
Annals of Occupational and Environmental Medicine.2025; 37: e24. CrossRef

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Review

Introducing statutory paid sick leave in South Korea: necessity and key considerations: Jinwoo Lee; Ann Occup Environ Med 2025;37:e22. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e22

Abstract Abstract in Korean PDF Supplementary Material: South Korea remains one of the few Organization for Economic Cooperation and Development countries without a statutory paid sick leave system or a public sickness benefit program. This paper examines the necessity of introducing statutory paid sick leave in South Korea and outlines key considerations for its implementation. The “right to rest when sick” is a fundamental health and labor right that ensures workers can recover from illness without risking job loss or income insecurity. A comparative review of international systems demonstrates that most countries have institutional mechanisms to support workers during non-work-related illnesses or injuries through paid sick leave and/or sickness benefits. In contrast, South Korean workers—especially those in small workplaces or non-regular employment—face limited access to such protections. The absence of these systems exacerbates social inequality and increases the risk of presenteeism and delayed medical care. Introducing statutory paid sick leave is not only a public health investment but also a measure to promote labor rights, reduce productivity losses, and prevent poverty caused by illness. The implementation of such a system must ensure universal coverage, prohibit employer retaliation, and be integrated with future sickness benefit programs to create a comprehensive social safety net.; 한국에서의 법정 유급병가 필요성과 도입 시 고려할 지점
한국은 법정 유급병가 제도 및 공적 질병수당 제도가 없는 몇 안 되는 OECD 국가 중 하나이다. 본 논문은 한국에서 법정 유급병가 제도의 도입 필요성을 검토하고, 제도 설계 시 고려해야 할 주요 사항들을 제시한다. ‘아플 때 쉬는 권리’는 노동자가 질병으로부터 회복할 수 있도록 보장하는 기본적인 건강권이자 노동권이다. 국제 비교를 통해 다수 국가들이 유급병가와 질병수당 제도를 통해 업무 외 질병 또는 부상 시 노동자를 지원하는 제도적 장치를 갖추고 있음을 확인할 수 있다. 반면, 한국의 노동자들—특히 소규모 사업장 종사자나 비정규직—은 이러한 보호로부터 배제되어 있는 경우가 많다. 이로 인해 사회적 불평등이 심화되고, 프리젠티즘(presenteeism) 및 의료 이용 지연의 위험이 증가하고 있다. 법정 유급병가 제도의 도입은 공중보건에 대한 투자일 뿐만 아니라, 노동권을 증진하고 생산성 손실을 줄이며 질병으로 인한 빈곤을 예방하는 수단이다. 제도 도입 시 보편적 적용, 사용자 불이익 조치 금지, 향후 수병수당 제도와의 연계를 통한 포괄적 사회안전망 구축이 핵심적으로 고려되어야 한다.

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Review

The status and implications of paid sick leave and sickness benefits in OECD countries: Jaehoon Lee, Jinwoo Lee, Sang Baek Koh; Ann Occup Environ Med 2025;37:e21. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e21

Abstract PDF Supplementary Material: The experience of the coronavirus disease 2019 pandemic has highlighted the importance of paid sick leave and sickness benefits, and is creating an international movement to introduce or improve real-world systems. The Organisation for Economic Co-operation and Development (OECD) countries except Korea and the United States already have statutory paid sick leave or sickness benefits, with the United Kingdom extending statutory paid sick leave to low-income workers in 2025, and Ireland introducing statutory paid sick leave in 2023. In the United States, 19 states, including Minnesota in 2024 and Alaska and Missouri in 2025, as well as the District of Columbia, have introduced statutory paid sick leave (as of December 2024). Furthermore, an analysis of 33 OECD countries with statutory paid sick leave or sickness benefits suggests that 21 countries comply with the International Labour Organization (ILO) Convention standards for adequacy of benefits and comprehensiveness of coverage, while six countries with social assistance have high comprehensiveness of coverage but low adequacy of benefits. There was not a single country with a program that had low levels of both benefit adequacy and coverage. In Korea, the pilot sickness benefit program has been extended until 2027, and the system has been delayed. The principles of benefit adequacy and coverage comprehensiveness must be upheld for the purpose and intent of the program to ensure adequate care and rest. Consequently, in addition to adhering to the standards outlined in the ILO Convention, the implementation of paid sick leave should be codified in legislation to enhance employer accountability.

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Research Article

Effect of teacher’s working conditions on voice disorder in Korea: a nationwide survey: Yi-Ryoung Lee, Hyoung-Ryoul Kim, Seyoung Lee; Ann Occup Environ Med 2018;30:43. Published online July 3, 2018; DOI: https://doi.org/10.1186/s40557-018-0254-8

Abstract PDF

Background

Korean teacher’s working conditions are deteriorating. There is concern about the deterioration of teachers’ health and voice disorder is one of the most common problems. Teacher’s vocal health is important for them and their students. The aim of the present study was to investigate working conditions that may affect voice disorders.

Methods

In all, 79 primary and secondary schools were randomly selected for a nationwide school system survey (N = 3345). In 64 schools, 1617 (48.3%) teachers participated via a postal self-report questionnaire from June 2016 to August 2016. After applying inclusion and exclusion criteria, data from 1301 teachers’ were used for analysis. Multiple logistic regression was used to investigate the associations between general, work-related factors, and frequent voice disorders (fVDs) to estimate the adjusted odds ratio(aOR).

Results

Teachers who reported voice symptoms more than once a week (fVD) made up 11.6%. In a multiple logistic regression, fVD was significantly associated with female, difficulty in applying for sick leave as needed, music teachers (primary school), and less than 6 h of sleep per day (primary school). The aOR for fVD was 2.72 (0.83–8.10) in the longest working hours group (> 52 h/wk) among the primary school teachers, and 1.90 (0.80–4.73) in the longest class hour group (≥ 20 h/wk), 1.52 (0.90–2.62) in homeroom teachers among the secondary school teachers, but not statistically significant.

Conclusions

Korean teachers’ working conditions are associated with fVDs. The school health system must take steps to prevent and treat voice disorders of teachers.

Citations

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Original Article

Association between Job Stress, Psychosocial Well-being and Presenteeism, Absenteeism: Focusing on Railroad Workers: Inn Shil Ryu, Dae Soon Jeong, In Ah Kim, Jae Hoon Roh, Jong Uk Won; Korean Journal of Occupational and Environmental Medicine 2012;24(3):263-273. Published online September 30, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.3.263

Abstract PDF

OBJECTIVES
The purpose of this study was to determine the current status of presenteeism and absenteeism among railroad workers as well as to investigate whether or not job stress level and psychosocial well-being status are associated with presenteeism and absenteeism.
METHODS
As the cross-sectional design, a self-reported questionnaire using the Korean Occupational Stress Scale(KOSS), Psychosocial Well-being Index(PWI), and Work Productivity and Impairment-General Health(WPAI-GH) was administered to railroad workers. Univariate and multivariate logistic regressions were used to analyze the association between job stress, psychosocial well-being status and presenteeism, absenteeism in 1,099 subjects.
RESULTS
Among the study subjects, 52.0% and 22.0% experiened presenteeism and absenteeism, respectively. Job stress level in railroad workers was higher than that in general workers. Multivariate logistic regression with presenteeism as the dependent variable showed an elevated odds ratio of 3.56(95% CI 1.48-8.54) in the highest job stress group, and an odds ratio of 3.20(95% CI 1.94-5.26) in the high-risk psychosocial stress group. There was no significant association between job stress level and absenteeism, whereas weak association between psychosocial stress and absenteeism was found.
CONCLUSIONS
Since railroad workers have a high level of job stress and elevated experience of presenteeism, a management strategy is required to control presenteeism and absenteeism in order to promote railroad workers' health and safety.

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