New York University's Robert F. Wagner Graduate School of Public Service, New York, New York.
JAMA Health Forum. 2021 May 6;2(5):e210342. doi: 10.1001/jamahealthforum.2021.0342. eCollection 2021 May.
More evidence on associations between mandated paid sick leave and health service utilization among low-income adults is needed to guide health policy and legislation nationwide.
To evaluate the association between New York City's 2014 paid sick leave mandate and health care utilization among Medicaid-enrolled adults.
This retrospective cohort study used New York State Medicaid administrative data for adults 18 to 64 years old continuously enrolled in Medicaid from August 1, 2011, through July 31, 2017. A difference-in-differences approach with entropy balancing weights was used to compare New York City with the rest of New York State to assess the association of the paid sick leave mandate with health care utilization, and for those 40 to 64 years old, with preventive care utilization. The data analysis was performed from June through August 2020.
Temporal and spatial variation in exposure to the mandate.
Annual health care utilization (emergency care, specialist visits, and primary care clinician visits) per Medicaid-enrolled adult. Secondary outcomes include categories of emergency utilization and utilization of 5 preventive services.
Of 552 857 individuals (mean [SD] age, 43 [12] years; 351 130 [64%] women) who met inclusion criteria, 99 181 (18%) were White, 162 492 (29%) Black, and 138 061 (25%) Hispanic. Paid sick leave was significantly associated with a reduction in the probability of emergency care (-0.6 percentage points [pp]; 95% CI, -0.7 to -0.5 pp; < .001), including a 0.3 pp reduction (95% CI, -0.4 to -0.2; < .001) in care for conditions treatable in a primary care setting and an increase in annual outpatient visits (0.124 pp; 95% CI, 0.040 to 0.208 pp; < .001). Among those 40 to 64 years old, the mandate was significantly associated with increased probabilities of glycated hemoglobin A level testing (2.9 pp; 95% CI, 2.5-3.3 pp; < .001), blood cholesterol testing (2.7 pp; 95% CI, 2.5-2.9 pp; < .001), and colon cancer screening (0.4 pp; 95% CI, 0.2-0.6 pp; < .001).
This retrospective cohort study of nonelderly adults enrolled in Medicaid New York State showed that mandated paid sick leave in New York City was significantly associated with differences in several dimensions of health care services use.
需要更多证据来指导全国范围内的卫生政策和立法，以了解强制性带薪病假与低收入成年人健康服务利用之间的关系。
评估纽约市 2014 年带薪病假规定与医疗补助计划中成年人医疗保健利用之间的关系。
设计、设置和参与者：这项回顾性队列研究使用了纽约州医疗补助计划的行政数据，包括 2011 年 8 月 1 日至 2017 年 7 月 31 日期间连续参加医疗补助计划的 18 至 64 岁成年人。采用差分差异法和熵平衡权重来比较纽约市和纽约州其他地区，以评估带薪病假规定与医疗保健利用之间的关联，对于 40 至 64 岁的人群，还评估了与预防保健利用之间的关联。数据分析于 2020 年 6 月至 8 月进行。
强制性带薪病假的时空变化。
每位参加医疗补助计划的成年人的年度医疗保健利用（急诊、专科就诊和初级保健临床医生就诊）。次要结果包括急诊利用的类别和 5 种预防服务的利用情况。
在符合纳入标准的 552857 名成年人中（平均[SD]年龄为 43[12]岁；351130[64%]为女性），99181 名（18%）为白人，162492 名（29%）为黑人，138061 名（25%）为西班牙裔。带薪病假与急诊护理可能性降低显著相关（-0.6 个百分点[pp]；95%CI，-0.7 至-0.5 pp； < .001），包括初级保健环境中可治疗疾病的护理减少 0.3 个百分点（95%CI，-0.4 至-0.2； < .001），以及门诊就诊次数增加（0.124 pp；95%CI，0.040 至 0.208 pp； < .001）。对于 40 至 64 岁的人群，该规定与糖化血红蛋白 A 水平检测（2.9 个百分点；95%CI，2.5-3.3 个百分点； < .001）、血胆固醇检测（2.7 个百分点；95%CI，2.5-2.9 个百分点； < .001）和结肠癌筛查（0.4 个百分点；95%CI，0.2-0.6 个百分点； < .001）的概率增加显著相关。
这项针对纽约州医疗补助计划非老年成年人的回顾性队列研究表明，纽约市强制性带薪病假与卫生保健服务使用的几个维度存在显著差异。
