Attending work despite illness (sickness presenteeism) is common in many workplaces. While most research has focused on individual and workplace determinants, less is known about country-level factors. This study examines (i) the association between national sick pay policies and presenteeism, (ii) the extent to which these policies contribute to cross-country variation in presenteeism, and (iii) whether associations differ by sociodemographic and occupational characteristics. We used data on 19 657 employees in 35 countries from the 2015 European Working Conditions Survey combined with country-level information on sick pay regulations. Countries were classified as offering ‘generous’ sick pay if they compensated from the first day of illness with ≥80% wage replacement for at least 2 weeks (43% of the countries met this criterion). Presenteeism was measured by the fraction of days worked while ill out of all illness days in the past 12 months (presenteeism propensity). We estimated multilevel models that controlled for individual characteristics (sociodemographics, job characteristics, health) and country features (unemployment, gross domestic product, and population density). Generous sick pay was associated with an 8-percentage-point lower presenteeism propensity (average marginal effect: −0.08; SE: 0.04; P < .05), explaining 12.4% of the between-country variance in presenteeism propensity. The association appeared more pronounced among older workers, low-income employees, routine occupations, and those in industry or public administration. National sick pay regulations may shape presenteeism, particularly among groups where financial motives are central. Adequate sick pay may help prevent workers from engaging in presenteeism and mitigate its consequences.