Abstract
BACKGROUND: The U.S. is one of the only developed countries in the world without a federal requirement that employers provide paid sick leave (PSL) to workers. We evaluated the association between state and local PSL mandates and health care utilization among U.S. workers. METHODS: We conducted a cohort analysis using administrative health insurance claims for 2.3 million private sector workers aged 40 to 64 from 2011 through 2019. Difference-in-differences models compared health care utilization before and after PSL mandate enactment between workers in areas with and without mandated PSL coverage. Outcomes included visits to primary care physicians (PCP), specialists, preventive care, diagnostic services, emergency department, urgent care visits, and hospitalizations. FINDINGS: PSL mandates were associated with an increased probability of a past year PCP visit (4.79pp; 95% CI, 1.39-8.19), specialist visit (2.71pp, 95% CI, 0.98-4.44), preventive care visit (2.75pp; 95% CI, -0.36 to 5.86), and outpatient diagnostic visits (2.20pp, 95% CI, 1.21-3.19). PSL mandates were also associated with increases in the average annual number of specialist, preventive care, outpatient diagnostic, and urgent care visits. Estimates were generally larger for those working in industries that have historically maintained low rates of PSL coverage in the U.S. INTERPRETATION: PSL mandates were associated with greater use of PCP, specialist, diagnostic, and preventive care services. These findings highlight the role for policies that enhance workplace flexibility, including PSL, to improve access to health care services. FUNDING: The research was supported by grant R01CA237888 from the National Cancer Institute.