Abstract
Context
The United States (US) is the only developed country that does not guarantee short-term
or longer-term paid sick leave.
Objective
This study used a multiyear nationally representative database to examine the association
between availability of paid sick leave and frequency of emergency department (ED)
use among US private sector employees.
Study sample
We used the National Health Interview Survey data (2012-2014). The final study sample
consists of 42,460 US adults between 18 and 64 years of age and working in nongovernmental private sector.
Results
Our results suggest that availability of paid sick leave is significantly associated
with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users
(4 or more times/year). After controlling for confounding factors, respondents with
paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio,
0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds
ratio, 0.68; 95% CI, 0.50-0.91).
Discussion
Although expansion of health insurance coverage under the Affordable Care Act has
not been shown to reduce utilization of high cost health care services such as the
ED, our study suggests other factors such as the availability of paid sick leave may
do so, by allowing patients to seek care through other more cost-effective mechanisms
(eg, primary care providers). To reduce ED utilization, health policymakers should
consider alternative reforms including paid sick leave.
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Article Info
Publication History
Published online: January 05, 2016
Accepted:
December 30,
2015
Received in revised form:
December 21,
2015
Received:
December 9,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
