The Link Between Sick Leave Laws and Emergency Department Visits

By Bianca Frogner, PHD
August 30, 2022

This week’s contributor is Bianca Frogner, a professor in the Department of Family Medicine and Director of the Center for Health Workforce Studies at the University of Washington School of Medicine. Her research focuses on how the health workforce can be used effectively to deliver high quality, accessible and affordable care. Bianca is a member of the 2022 Tradeoffs Research Council.

Almost a quarter of the U.S. working population did not have paid sick leave in March 2020, as the coronavirus pandemic began roaring across the country, harming workers and their families. More than two years later, the U.S. is still one of the only industrialized countries without comprehensive, federally mandated paid sick leave.

But there has been action on the state level. A new study in Health Affairs examined years of state mandates for paid sick leave in an effort to determine the benefits that local and state mandates might provide. The research, led by Yanlei Ma of Harvard Pilgrim Health Care Institute, could inform discussions about paid sick leave on both state and national levels, especially in light of the ongoing impact of COVID-19 variants. 

The team of investigators looked at the effects of paid sick leave mandates in seven states (Arizona, Maryland, Massachusetts, New Jersey, Oregon, Rhode Island and Vermont) using publicly available Healthcare Cost and Utilization Project (HCUP) data over the period of 2011-2019. Specifically, the researchers analyzed how emergency department (ED) use changed before and after the states implemented mandates, and compared the numbers to those in states without mandated paid sick leave. Among the findings:

  • States that implemented paid sick leave mandates saw 23 fewer ED visits per 1,000 patients per year than states without mandates.
  • Some of the biggest reductions in ED visits included those associated with injuries and with mental health/substance use disorders. 
  • Medicaid patients drove most of the decline in ED visits, with 70 fewer visits per 1,000 patients in the Medicaid population per year compared to states without mandates.
  • If all U.S. workers had been offered paid sick leave in 2019, the country’s health care system would have saved between $2.1 to $2.7 billion in that year alone.

This study underscores the particular benefits of paid sick leave for communities disproportionately affected by mental health issues or those on Medicaid, who work lower paying jobs less likely to voluntarily offer sick leave. Those benefits only become more essential during a public health crisis like COVID-19.

In the first year of the pandemic, the Families First Coronavirus Response Act required employers to cover two weeks of paid sick leave for issues related to COVID-19. Permanently expanding that benefit to all Americans has been considered in recent policy discussions, but has not yet passed. As fast-spreading variants continue to dominate, and government officials loosen public health measures, people will continue to get sick with COVID-19. Though cases may result in less severe outcomes given widespread vaccinations and the availability of effective treatments, by expanding paid sick leave to all Americans, this study suggests the country may be able to avoid costly complications and unnecessary ED use while also minimizing transmission of the virus.

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