Malaysian employers would often have to pay for poor employee health through medical claims. But another reason for poor-health-related payments that often goes unnoticed is the lack of daily productivity.

Absenteeism is easy to spot - someone's out, and a line appears on a report. Presenteeism is the opposite. Though an employee is at their desk, logged in, they may be working at a fraction of their normal output because of illness, poor sleep, chronic stress, or an untreated health condition. It doesn't show up on any leave register. It presents itself in missed deadlines, slower service, and increased errors.

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Numbers behind the invisible cost  

Based on a 2019 survey by AIA Vitality Malaysia, Malaysian organisations lose an estimated RM1.46 million a month due to absenteeism and presenteeism, amounting to around 73.3 productivity-days lost per employee yearly. That's not a rounding error in a wellness budget; it's a recurring, unbudgeted strain on output.

Presenteeism is the more glaring problem. A study was conducted on the impact of migraines on productivity and monetary loss among employees in Malaysian banking sectors. It was found that presenteeism cost employers RM5,392.60 per employee, compared with RM1,548.30 for absenteeism — about 3.5 times higher (Wong et al., The Journal of Headache and Pain, 2020). It seemed the "working while unwell" cost overtook the "not showing up" cost, signalling a pattern that likely occurs across other conditions and industries.

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Lower-income employees most affected

In a separate study across 47 Malaysian companies, results showed that impairment while working due to poor health was highest among lower-income staff (Wee LH, et al., BMC Public Health, 2019). It concluded that the key drivers behind absenteeism and presenteeism were a combination of socioeconomic, physical, and mental health factors. Those with lower income may seek out second jobs or work longer hours, affecting their sleep, stress levels, and physical health.  

In other words, presenteeism is not randomly distributed, but concentrates on segments of the workforce that are hardest to support through generic wellness programmes. They are often easily overlooked until turnover or output problems arise.

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Why it stays invisible until someone looks at the data

Today's employee mental health strain is well-documented. However, most Malaysian organisations still struggle to connect that strain to actual productivity loss. Especially so if presenteeism easily goes unnoticed and never appears on a balance sheet.  

The only trail presenteeism leaves is in the benefits data, such as claims patterns, GP visit frequency, prescription trends, and utilisation spikes. The standalone data may look unremarkable; but read together, they tell a very different story about which teams, roles, or conditions are quietly costing the most.

This is where TPA-managed data changes things. Instead of guessing employee wellbeing from in-person observations, hearsay, and engagement surveys alone, employers can track and spot early signals sitting inside their own claims and utilisation data. A missed target, or a spike in short-term medical leaves could be an indication of presenteeism.  

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What presenteeism looks like

Presenteeism tends to surface as a handful of quiet, easy-to-miss patterns rather than one big, waving red flag. What you can look into instead:

• Repeat minor-condition GP visits — The same employee seeing a doctor for the same minor complaint (headaches, gastric issues, fatigue) every few weeks, rather than once and resolved. ‍
• Increased prescription refills — An employee’s ramped-up treatment for chronic, stress-linked, or sleep-related conditions, without a parallel utilisation of medical leave. ‍
• Always on, yet still behind — Employees logging in early and staying late, yet consistently missing deadlines or producing more errors than usual. ‍
• Stable attendance, slipping output  — While a team's headcount and leave record look normal, their work quality or response times have quietly taken a hit. ‍
• Reported changes — Managers observe and share an employee’s noticeably shorter tempers, withdrawal in meetings, or that they "just aren’t quite themselves", without any corresponding sick leave.

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Individually, each of these appears as noise. Read together against claims and utilisation data over a few months, they form a pattern. These patterns help to surface issues early instead of suffering a business cost after a resignation or missed deadline. It also reveals things organisations can do to manage the effects of presenteeism.

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What organisations can do about it

Rather than treating presenteeism as a human willpower problem, treating it as a workplace design issue would be more effective and sustainable. Malaysian employers are currently incorporating these measures:

• Destigmatise taking a sick day — In some organisations, employees will show up sick at work for pressure of being judged or penalised. Clear, unbiased medical leave policies, reinforced by leadership actually taking their own leave, removes the pressure. Make it genuinely easy to be absent when unwell. ‍
• Train managers to spot the signs, not just the absences — Most manager training focuses on attendance. Presenteeism needs the opposite skill: noticing when someone is struggling though they show up. And knowing how to start a conversation without it feeling like a performance review. ‍
• Widen access to support beyond a phone number in the handbook — Communicating the availability of an Employee Assistance Programme (EAP) could help people know it exists and can reach it easily, all in confidence. ‍
• Target interventions using data — Generic wellness campaigns may not be effective across an entire workforce. Analysing claims and utilisation data can show which teams, roles, or conditions are driving the bulk of the cost. This way, budget goes where it will move the needle. You may notice lower-income employees or high-stress functions go first, per the research above. ‍
• Review the employee benefits design — If there’s an obvious gap between the claims data and coverage limits, it’s a sign to restructure the benefits package.  

None of this requires a large new budget; it requires visibility into data you may already have, just not yet connected. If you'd like to see how HealthMetrics can assist you with real-time utilisation and claims data, speak to us here.

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Presenteeism is costly but can be spotted for intervention

It's clear that presenteeism in the workplace, or rather its effects, contributes to escalated costs, compared to that of absenteeism in the long term. However, as discussed earlier, it's often only noticed much later in poor output and resignations. Not to worry - spotting presenteeism in your workforce is much simpler than you think. All the signs sit inside benefits usage data, which you can peruse, find patterns, and put in actionable efforts before presenteeism becomes a visible productivity problem.

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We've prepared a downloadable guide and checklist for your safekeeping and tracking at your own organisation!

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Sources

• AIA Vitality, Malaysia's Healthiest Workplace Survey, 2019 (cited via Naluri)
• Wong LP, et al. "Presenteeism and absenteeism costs of migraine in Malaysia." The Journal of Headache and Pain, 2020;21(1):68. PMC7282083
• Wee LH, et al. "Anteceding factors predicting absenteeism and presenteeism in urban area in Malaysia." BMC Public Health, 2019;19(Suppl 4):540. PMC6565599

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