Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
Am J Ind Med. 2011 Oct;54(10):771-9. doi: 10.1002/ajim.20988. Epub 2011 Jul 14.
In identifying factors of health care use, past research has focused on individual-level characteristics or on the health care system itself. This study investigates whether access to paid sick days, an amenable environmental factor outside the health care system, is associated with primary and emergency care use.
A nationally representative sample of 14,302 U.S. working adults extracted from the 2007 National Health Interview Survey data was used. Multiple logistic regressions were performed, controlling for demographic variables, health conditions and status, and access to health care.
Workers with lower socioeconomic status, poorer health status, or without health insurance or regular places for care were more likely to lack paid sick days than higher-status workers. For all U.S. working adults, access to paid sick days benefits was significantly associated with increased use of outpatient care but not with reduced use of ER. For U.S. working adults with health insurance coverage, access to paid sick days benefits was significantly associated with increased use of outpatient care and reduced use of emergency care.
A public policy mandating paid sick days may help facilitate timely access to primary care, reduce avoidable emergency care use, and reduce health disparities among workers.
在确定医疗保健使用的因素时，过去的研究主要集中在个人层面的特征或医疗保健系统本身。本研究调查了获得带薪病假（医疗体系之外的一个可改变的环境因素）是否与初级保健和急诊服务的使用有关。
本研究使用了来自 2007 年全国健康访谈调查数据的 14302 名美国在职成年人的全国代表性样本。通过多变量逻辑回归，控制了人口统计学变量、健康状况和健康服务的可及性。
与社会经济地位较高的工人相比，社会经济地位较低、健康状况较差、没有医疗保险或没有固定就诊地点的工人更有可能没有带薪病假。对于所有美国在职成年人来说，获得带薪病假福利与增加门诊服务的使用显著相关，但与减少急诊服务的使用无关。对于有医疗保险的美国在职成年人来说，获得带薪病假福利与增加门诊服务的使用和减少急诊服务的使用显著相关。
制定带薪病假的公共政策可能有助于促进及时获得初级保健服务，减少不必要的急诊服务使用，并减少工人之间的健康差异。
