No paid sick leave means U.S. workers skip medical care: Study

Only 19 per cent of part-time workers have benefit

(Reuters Health) — U.S. workers without paid sick leave are more likely to keep going to work when they're sick and to forgo medical care for themselves and their families, compared to workers who do get paid for sick days, according to a new study.

Not only are workers with paid sick leave more likely to stay home to care for themselves or family when needed, but "more importantly, (paid sick leave) enables workers to 'self-quarantine' when necessary, without the worries of losing their job or income while also not spreading illness to others," which is especially important in the food service, healthcare and child care industries, said lead author LeaAnne DeRigne of Florida Atlantic University in Boca Raton in email to Reuters Health.

"These are occupations which frequently do not offer paid sick leave benefits," said coauthor Patricia Stoddard-Dare of Cleveland State University in Ohio, also by email.

While 70 per cent of the U.S. workforce in full-time jobs has paid sick leave, only 19 per cent of part-time workers have that benefit, the authors write in Health Affairs, March 7.

The researchers used data from the 2013 National Health Interview Survey on a representative proportion of the civilian non-institutionalized population. More than 18,000 working adults ages 18 to 64, one from each included family, were interviewed by a Census Bureau employee in person or by phone.

Roughly 10,500 participants had paid sick leave benefits, while 7,800 did not. Those without were more likely to be male, unmarried, less educated, Hispanic, to work in the service industry, to work part time, be uninsured and have poor health.

Overall, those without paid leave were three times as likely to skip medical care for themselves compared to those with paid leave.

Uninsured people with annual family income below $35,000 were most likely to skip medical care because of cost, with 11% saying they did so in the past year. In the same income bracket, 14% said a family member had delayed care because of cost.

As annual income increased, the risk of skipping care decreased, and the risks were smaller for insured families.

Evidence suggests that paid sick leave is tied to increased job stability and employee retention following illness, injury, or birth of a child, increased worker productivity, decreased worker errors, decreased accidents or injuries on the job, and when used to augment maternity leave, paid leave increases well-baby visits, maternal health, and the duration of breastfeeding, while also decreasing infant mortality, the authors note in their paper.

Delaying needed medical care can lead to more complicated, disabling, and expensive health conditions, while missing work without paid leave adds lost wages to the cost of medical care, DeRigne said.

"We believe all workers should have access to guaranteed paid sick leave benefits," DeRigne said.

"One surprising aspect of our work with paid sick leave is the consistency with which we find negative outcomes associated with workers who lack these benefits," DeRigne said. "These negative effects remain even when controlling for other factors, such as household income, health status, health insurance, education, race, marital status among others."

"In most countries, paid sick leave is regulated by legislation and relates to all enterprises in the countries concerned," said Xenia Scheil-Adlung, health policy co-ordinator in the Social Protection Department of the International Labor Organization in Geneva, Switzerland.

Paid sick leave should be available to all workers as part of decent working conditions, Scheil-Adlung told Reuters Health by email.

"Financial protection in case of sickness includes both coverage of health care costs and income replacement," she said.

And given the higher productivity of healthy workers, paid sick leave has a return on investment for employers, Scheil-Adlung said.

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