Paid Sick Leave Results in Higher Utilization of Preventive Services

A new study suggests that paid sick leave is a crucial component for workers to use preventative services, such as visiting their primary care physician or receiving a flu shot.

Through the Affordable Care Act (ACA), individuals are able to receive preventive screenings recommended by the US Preventive Services Task Force with no cost-sharing. However, many do not utilize these free services, especially if their employer does not provide their workers with sick leave.

Findings from a new study published by Preventive Medicine highlight the importance that sick leave benefits play in employee and public health. However, paid sick leave is not required of employers, so not all Americans have access.

"Compared to 22 similarly developed countries, the United States is the only one that does not mandate employers to provide paid sick leave benefits or include paid sick leave in a universal social insurance plan," said lead study author LeaAnne DeRigne, PhD.

Included in the study were 13,545 adults aged between 16 and 64, who were employed and took part in the National Health Interview Survey.

The study authors examined the prevalence of preventive care utilization, such as blood pressure check, cholesterol check, fasting blood sugar check, receiving a flu shot, primary care visits, receiving a Pap test, receiving a mammogram, and undergoing colon cancer screening. The authors controlled for gender, marital status, education, race/ethnicity, full time work, insurance, overall health, health conditions, family income, age, and family size.

The study authors found that workers who did not have paid sick leave were observed to be significantly less likely to have received a preventive screening within the last year. Notably, these findings even proved true in high risk populations, such as individuals diagnosed with diabetes or heart disease, according to the study.

Compared with those who have access to paid sick leave, individuals without were 1.6 times less likely to receive a flu shot within the past 12 months.

The study authors also found that workers without sick leave were 30% less likely to have their blood pressure checked, and 40% less likely to have their cholesterol checked within the last 12 months, according to the study. These screenings are important, because high blood pressure and cholesterol can impact heart function and increase healthcare costs.

Additionally, this population was 24% less likely to have undergone a fasting blood sugar screening to detect diabetes over the past year. Women without sick leave were 23% less likely to have a Pap test in the past year, according to the study.

The study authors found that patients without paid sick leave were also 19% less likely to have visited or communicated with a healthcare provider within the past year.

However, paid sick leave was not observed to impact screenings for colon or breast cancers. The study authors hypothesized that more workers are likely to receive mammograms because their availability has expanded to mobile units and other innovative approaches that may not require sick time.

The researchers noted that because colon cancer screenings are recommended every decade, participants may not have been required to receive a screening within the past year, which could have altered results, according to the study.

"Our findings demonstrate that even when insured adults are provided with free preventive screenings, paid sick leave is a significant factor associated with actually using the screenings," Dr DeRigne said. "American workers risk foregoing preventive health care, which could lead to the need for medical care at later stages of disease progression and at a higher cost for workers and the American health care system as a whole."

Common ways to increase paid sick leave benefits is by mandating employer-funded benefits or implementing a universal insurance program, which have been used by other countries. The Healthy Families Act, which was introduced to Congress in 2015, would have required employers with more than 15 employees to provide up to 7 paid days of sick leave, and provide 7 unpaid days for employers with less than 15 employees. However, the bill was not passed and has not been introduced to Congress in 2017.

These new findings suggest that healthcare reform should include providing paid sick leave for employees, and may be a beneficial provision for lawmakers to consider while devising a plan to replace the ACA.

"Our data can be used by health care professionals, policy makers and others to consider the expansion of access to evening and weekend hours as well as mobile, community-based, and workplace health and wellness services," said study co-author Patricia Stoddard-Dare, PhD. "When workers forgo essential preventive health care such as flu shots, the public health implications are immense. This is particularly relevant for service related employees, food preparation workers and others who have low access to paid sick leave coverage."