Callison Kevin, Pesko Michael F, Phillips Serena, Sosa Julie Ann
Department of Health Policy and Management, Celia Scott Weatherhead School of Public Health, Murphy Institute of Political Economy, Tulane University, 1440 Canal St., Suite 1900, New Orleans, LA, 70112, United States.
Department of Economics, College of Arts and Science, University of Missouri, 615 Locust St., Columbia, MO, 65211, United States.
Lancet Reg Health Am. 2025 Jul 7;49:101174. doi: 10.1016/j.lana.2025.101174. eCollection 2025 Sep.
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.
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.
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.
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.
The research was supported by grant R01CA237888 from the National Cancer Institute.
美国是世界上仅有的几个没有联邦要求雇主为工人提供带薪病假（PSL）的发达国家之一。我们评估了州和地方的带薪病假规定与美国工人医疗保健利用之间的关联。
我们使用2011年至2019年230万年龄在40至64岁的私营部门工人的行政医疗保险索赔进行了队列分析。差异-in-差异模型比较了有和没有法定带薪病假覆盖地区的工人在带薪病假规定颁布前后的医疗保健利用情况。结果包括看初级保健医生（PCP）、专科医生、预防保健、诊断服务、急诊科、紧急护理就诊和住院情况。
带薪病假规定与过去一年看初级保健医生的概率增加（4.79个百分点；95%置信区间，1.39 - 8.19）、看专科医生的概率增加（2.71个百分点，95%置信区间，0.98 - 4.44）、预防保健就诊概率增加（2.75个百分点；95%置信区间，-0.36至5.86）以及门诊诊断就诊概率增加（2.20个百分点，95%置信区间，1.21 - 3.19）相关。带薪病假规定还与专科医生、预防保健、门诊诊断和紧急护理就诊的年均次数增加相关。对于在美国历史上带薪病假覆盖率一直较低的行业工作的人，估计值通常更大。
带薪病假规定与更多地使用初级保健医生、专科医生、诊断和预防保健服务相关。这些发现凸显了增强工作场所灵活性的政策（包括带薪病假）在改善医疗保健服务可及性方面的作用。
该研究由美国国立癌症研究所的R01CA237888资助。
