As a general rule, Americans are bred to be hard workers, even when they’re sick. However, a recent study out of the San Francisco-based Integrated Benefits Institute shows the short-term productivity gains of working through illness could affect long-term productivity costs.

“The issue becomes problematic when you have people who are saying that when they’re ill, they go to work anyway and work a modified routine,” says Brian Gifford, senior research associate and one of the study’s co-authors.

“We don’t know what their performance is like on the job,” he says, “but when they say they have too much work to do to take time off, [then] people aren’t taking care of their own health. If these are acute episodes related to a chronic illness and they don’t take time off to recuperate, they may be worsening the problem by causing a more serious illness, which could require longer-duration disability leave or even lead to early exit from the workforce.”

Flu symptoms aside, Gifford says issues — including mental-health issues, back pain and other problems — tend to lower job performance.

“Some people have chronic issues, and every day they’re performing less and less, thinking that it’s not legitimate to take time off,” he says. “When people are working so hard that they’re not attending to their health, this causes long-term consequences.”

To combat this, HR leaders need to develop programs or structure benefits in a way that allows an individual who’s truly ill to take the time they need to get better and not feel penalized, says Jackie Reinberg, a senior consultant in Towers Watson’s Philadelphia office.

Reinberg says sick leave gives workers the ability to demand discretionary time, but only a small amount of people are taking it. Indeed, a recent Towers Watson survey found that, on average, people use between two and five days of sick leave a year.

“Paid time off provides a no-fault way that makes it OK for employees to go home and get better,” she says.

And while flexible work schedules may prove helpful to sick workers in some industries, says Reinberg, it’s simply not possible for workers in industries such as manufacturing or retail.

Therefore, “prevention is the best policy. Health and productivity programs keep a workforce healthy and engaged,” she says, adding that research has found organizations that invest in health strategies have 1.3 less absence days per 100 employees.

Research has also shown that people who have access to paid-leave policies heal faster and are ready to go when they come back to work, says Jeff Hayes, study director for the Washington-based Institute for Women’s Policy Research.

“PTO policies are effective,” he says. “The evidence shows that you can save money when people are more likely to return to same employer, which provides long-term productivity benefits.”

Hayes says that recent IWPR research showed half of U.S. workers take “zero” hours of sick leave a year.

“They show up sick,” he says, “even people with access to paid sick days. The median taken is three a year, and there’s little evidence that U.S. workers abuse this.”

This issue will become more acute when the employer mandate kicks in next year, says Rich Fuerstenberg, disability- and absence-management expert in the health and benefits business of Washington-based Mercer.

“The cost of bringing in a substitute worker would not just be about payroll costs,” he says. “If the strategy is to not allow people to work more than 30 hours a week, that creates more complexity and more costs associated with that absence. This is an issue that needs to be on HR’s radar.”

On-site clinics for companies in remote locations can help employees with basic preventative care and physical therapy, says Fuerstenbeg.

“This can impact more than healthcare costs, and telemedicine is another way of leveraging that capability,” he says. “Some employers have even set up video conferencing and are integrating that into their disability programs.”

Whether a medical issue is minor or major, preventative or manageable, he says, the disability vendor is someone the employee has to talk to, and that’s a teachable moment. Employees should receive a call from a health coach who lets them know about programs that exist.

“That’s the perfect time to get them into a management program,” he says.

Getting workers to buy into a health-management program may be an easier task if the company’s culture supports such efforts from the get-go, says Matt Nagler, a managing partner of the Bedford, N.H.-based BANK W Holdings, which is the parent company of three specialized staffing firms and winner of numerous awards for workplace culture.

“The overall culture of flexibility and people being invested in us as an organization started from the first day we opened our doors 10 years ago,” says Nagler. “One of the goals of our organization was that someone could have a long-term career here … . People who work here are able to grow and develop their career with us and stay with our organization and be productive.

“Relationship drives what we do, and there’s a huge value to that,” he says, “both for our team internally and externally with our clients.”

Nagler says BANK W Holdings has a generous PTO policy because, he says, “in a very connected day and age, people feel pressure to be at the office, and that includes when they’re ill. It starts with a culture that when people are sick, their health and their colleagues’ health comes first. Don’t bring illness into the office.”

He says the company’s PTO plan starts out generous and then “continues to increase” with an employee’s tenure.

“We don’t want people to feel that if they’re sick, then they can’t take a vacation,” he says, “because it will limit their time off. We built our PTO policy to be generous without being over the top. People don’t feel like taking that [sick] time will negatively affect them. This started with the culture and led to the policy.”

When a new employee joins the organization, he says, “they have to understand how they need to be here, and it needs to be reinforced.

“Restrictive policy is what you learn, and it’s a hard habit to break.” he says. “But we say ‘If you come in sick and you’re unfocused, it’s better for you to take a few days and handle that issue than impact the company and other employees.’ Once they understand that, and they’re not looked down upon for taking time off, they get it.”