SPECIAL Medical leave: Romania versus Europe and the USA

In Romania, starting from February 1, 2026, the medical leave system has become more restrictive than before, but it continues to be based on mandatory health contributions, which strongly raises the issue of "I pay for insurance, but I am not fully covered in case of illness." This is also the reason why the Ombudsman challenged on Tuesday at the Constitutional Court the emergency ordinance that eliminated the payment for the first day of medical leave. Against this backdrop, we attempt to synthesize and analyze how other states regulate medical leave, which states have systems similar to Romania's and which differ substantially.

Romania is not an isolated case; there are European models that provide for similar unpaid waiting periods, but the unique application, without distinction of vulnerability, has sparked strong criticism, both in terms of possible unconstitutionality and through its disproportionate impact.

Romania: mandatory contribution and unpaid first day

As we already know, Emergency Ordinance 91/2025 introduces the rule that, until December 31, 2027, the first day of medical leave is no longer paid by anyone (neither the employer nor the public system). From August 1, 2025, the medical leave allowance for ordinary illness (code 01) varies depending on its duration: 55% of the calculation base for leaves up to 7 days, 65% for leaves of 8-14 days, 75% for leaves over 15 days. From the gross allowance, in general, 25% is withheld for social security contributions, and 10% for health insurance contributions applies only to certain types of leave (ordinary illness, quarantine, reduction by ¼ of the workload).

The Ombudsman argues at the Constitutional Court that the non-payment of the first day, under conditions where the health contribution is mandatory and specifically designated (FNUASS), empties the right to social protection of its content and transforms the contribution into a "hidden tax."

This combination – mandatory contribution, dedicated fund, and explicit exclusion of one day from the allowance – is a central element in the comparison with other European countries and the USA.

Which countries have imposed leave models with "waiting days," similar to Romania's logic

Several European countries provide for one or more unpaid waiting days, especially for short leaves; however, the difference is that there the logic of waiting is already integrated into the system's design, not temporarily introduced over an already acquired right.

In Spain, typically, the first three days of medical leave are unpaid, then, until day 15, 60% of the salary is paid, and after day 15, the percentage increases to 75%, with allowances covered by the social security system.

In France, there are 3 unpaid incapacity days (jour de carence), after which, depending on seniority and insurance, the employee receives about 50% of the salary from social insurance, and many collective contracts supplement this to 90-100%.

In Portugal, the first days are also unpaid, then the allowance is paid from the social security system, with percentages that increase with the duration of the illness (around 55-75% of the salary).

Countries like Latvia and Lithuania also provide for unpaid days. In the case of Latvia, the first day is unpaid, then payment is ensured by the employer, followed by state coverage.

In these countries, therefore, social contributions are mandatory, and the state or social security covers, after the waiting period, a significant part of the income; additionally, employers often fully support the first weeks (Belgium, partially France).

Models with very generous coverage

In Germany, the employer pays 100% of the salary for up to 6 weeks per year for the same episode of illness, provided that a medical certificate is presented. Subsequently, health insurance (Krankenkasse), funded from mandatory contributions, pays 70% of the salary for up to about 78 weeks within 3 years, with ceiling limits.

In The Netherlands, the employer typically pays 70% of the salary for up to 2 years of illness, based on a legal obligation, and there are typically no unpaid waiting days imposed by the state.

In Denmark, Norway, and Luxembourg, the medical leave systems are also generally more generous than the current formula in Romania, both in terms of duration and level of allowance.

In Denmark, employees are usually entitled to 100% of their salary from the first day of illness, paid by the employer, for about the first 30 days (a rule provided by labor law and most collective contracts). After this period, sickness benefits from local authorities (kommune) intervene, with a weekly benefit ceiling (for example, in 2024, 4,520 Danish crowns per week), the difference up to the full salary can be fully covered by the employer if the contract provides for it.

There is no general rule of "unpaid first day" imposed by the state; social contributions finance the public component, while employers have a clear legal obligation to cover the salary in case of illness. Compared to Romania, where the first day is not paid at all currently, and the remaining days are typically compensated at about 75% of the calculation base, the Danish model offers both 100% coverage and continuity between the employer and the public scheme.

In Norway, employees are entitled, if they have at least four weeks of seniority, to 100% of their salary during medical leave, with a mixed funding mechanism. The employer pays 100% of the salary for the first 16 calendar days of illness (the so-called "employer's period"). From the 17th day, responsibility passes to the National Insurance Scheme, which continues to pay the allowance at 100% of the calculation base, but only up to a ceiling.

The total duration of the right to sickness benefits can reach, in general, up to 12 months, which places Norway among the countries with the longest paid medical leave periods at a high level. In contrast, Romania limits primarily the level of the allowance (75% for ordinary illness) and introduces an unpaid zero day, even though health insurance contributions are mandatory.

Luxembourg is also among the top of the rankings for paid medical leave, with a system that combines the responsibility of the employer and social insurance. Employers typically pay the full salary for the first weeks of illness (approximately up to 77 days within a certain reference period), after which the National Social Security Fund intervenes, continuing to pay allowances. The level of compensation remains high (almost 100% of the salary) for an extended period, making Luxembourg, along with Germany and Switzerland, one of the countries with the most favorable medical leave conditions.

The USA and the fight for health

The health insurance system in the United States is fragmented, dominated by private insurance linked to employment, supplemented by public programs such as Medicare and Medicaid, and the right to paid medical leave is not guaranteed at the federal level for private sector employees.

In short, Medicare is the federal health insurance program primarily aimed at people aged 65 and over, but also for some categories under 65 who have disabilities or serious illnesses, such as end-stage renal disease or amyotrophic lateral sclerosis (ALS). Meanwhile, Medicaid is, in contrast, a federally funded health insurance program administered at the state level, aimed at low-income individuals: low-income families, children, pregnant women, the elderly, and people with disabilities, with specific eligibility varying from state to state.

Unlike Romania, where the health contribution is mandatory and medical leave is uniformly regulated, in the USA access to insurance and paid sick days largely depends on the employer and the state legislation in which you work.

In terms of insurance, most Americans under 65 are covered by health insurance provided by their employer, for which companies pay, on average, about 85% of the insurance cost for the employee and 75% for family members covered under the employee's policy, with the remainder being borne by the employee. The structure of copayments and deductibles is, however, significant: families can end up bearing hundreds to thousands of dollars annually out of pocket through deductibles, copayments, and coinsurance, even if they are insured.

Regarding medical leave, the United States does not have a federal law requiring private employers to provide paid sick days; the Family and Medical Leave Act (FMLA) offers up to 12 weeks of medical leave, but unpaid, for eligible employees in larger companies. The situation is partially corrected at the state level: by 2026, about 20-22 states plus Washington D.C. have introduced laws requiring employers to provide a minimum number of paid sick leave hours, typically accrued (for example, one hour of paid leave for every 30 hours worked, with an annual cap of 40-56 hours). In the remaining states, payment for sick days remains at the employer's discretion, meaning that millions of employees either have no paid sick leave at all or only a few days, provided internally.

In Romania, there is a unified right to paid medical leave, correlated with the payment of contributions, but an unpaid zero day is introduced; in the USA, access to paid medical leave depends on the state and the employer, without a federal minimum standard; while health insurance in Romania is public and universal for taxpayers, in the United States it remains a mosaic of private policies and public programs, with a high level of direct payments from patients.

Synthesis made with the help of a data monitoring flow provided by the media monitoring platform NewsVibe Romania. The analysis presented has been enhanced with the help of Machine Learning and Artificial Intelligence tools.