The United States lags behind 22 other highly ranked countries in terms of economic and human development when it comes to mandating employers to provide paid sick leave. In the U.S., only four states (Connecticut, California, Massachusetts and Oregon) along with a few dozen municipalities, now mandate paid sick leave as an employee benefit. That leaves 49 million U.S. workers without paid sick leave, causing an even greater divide in health care disparities as well as undesirable health care outcomes.

A study published in the March issue of Health Affairs by researchers at Florida Atlantic University and Cleveland State University, is the first to examine the relationship between paid sick leave benefits and delays in medical care and forgone medical care for both working adults and their family members. The researchers also analyzed the risk of emergency department use and the risk of missing work because of illness or injury by paid sick leave status, as well as the interaction effects between paid sick leave and family income and health insurance.

"Paid sick leave is an important employer-provided benefit that helps workers and their dependents receive prompt preventive or acute medical care, recuperate from illness faster, and avert more serious illness," said LeaAnne DeRigne, Ph.D., lead author of the study and associate professor in the School of Social Work at FAU. "Results from our study contradict public health goals to reduce the spread of illness, and policy makers should consider the potential public health implications of their decisions when contemplating guaranteed sick leave benefits."

Key findings from the study, which are representative of the nation, showed that regardless of income, age, race, occupation, full-time or part-time work status, health status or health insurance coverage, workers without paid sick leave were three times more likely to delay medical care than were workers with paid sick leave. They also were three times more likely to forgo needed medical care altogether. Furthermore, families of workers without paid sick leave were two times more likely to delay medical care and 1.6 times more likely to forgo needed medical care. The lowest-income group of workers without paid sick leave were at the highest risk of delaying and forgoing medical care for themselves and their family members -- making the most financially vulnerable workers the least likely to be able to address health care concerns in a timely manner.

The researchers also found that working adults with paid sick leave benefits missed one-and-a-half days more of work because of an illness or injury compared to workers without paid sick leave, indicating that they were more likely to take time off work to care for themselves or family when needed.

"There are so many positive outcomes related to providing paid sick leave that more employers should consider voluntarily offering this benefit," said Patricia Stoddard-Dare, Ph.D., associate professor of social work at Cleveland State.

For the study, DeRigne and her collaborators used data from the 2013 National Health Interview Survey (NHIS), an ongoing data collection initiative which began in 1957 and was designed to provide information on a broad range of health topics. The analytic sample included 18,655 working adults ages 18-64 -- identifying 10,586 working adults with paid sick leave benefits and 7,879 without paid sick leave benefits. They used 13 control variables in the study including race, ethnicity, marital status, education, family size, occupation, full-time or part-time work status, health insurance coverage, age, presence of a limiting condition, and total annual family income.

"The personal health care consequences of delaying or forgoing needed medical care can lead to more complicated and expensive health conditions," said DeRigne. "U.S. workers with paid sick leave are more likely to take time off work to care for themselves or for family when needed. More importantly, it enables workers to 'self-quarantine' when necessary, without the worries of losing their job or income while also not spreading illness to others. This is especially important for food service, health care and child care industries where the spread of illness can have large public health impacts. In recent news, corporations such as Chipotle are enacting new paid sick leave benefits to try and stop the spread of viruses such as Norovirus and E-coli."

DeRigne further underscores the importance of paid sick leave. "During the 2009 H1N1 influenza outbreak, the Centers for Disease Control and Prevention recommended that people infected stay home. Yet, estimates suggest that employees who did not stay home infected an additional 7 million people, and that lack of paid sick leave resulted in about 1,500 additional deaths during this outbreak."

Stoddard-Dare observes, "Workers who come to work when ill are also more prone to injuries and mistakes; therefore, offering paid sick leave may make good business sense."