Historically, most of the research on paid sick leave has focused on employer-based policies and the economic impacts on income and employment.9,10,11,12,13 Less research has examined how state-mandated paid sick leave affects access to leave-taking and employee health outcomes. More strong causal studies are needed to examine the impact of paid sick leave on access to well visits and health outcomes for parents and children. Because causal research that focuses on parent and child outcomes is still limited, the strong causal studies included in this review focus on working adults approximately ages 18 to 64, some of whom may be parents.
The research discussed here meets our standards of evidence for being methodologically strong and allowing for causal inference, unless otherwise noted. Each strong causal study reviewed has been assigned a letter, and a complete list of causal studies can be found at the end of this review, along with more details about our standards of evidence and review method. The findings from each strong causal study reviewed align with one of our eight policy goals from Table 1. The Evidence of Effectiveness table (Table 2) displays the findings associated with paid sick leave (beneficial or equivalent, nullii, or detrimental) for each of the strong studies (A through K) in the causal studies reference list. For each indicator, a study is categorized based on findings for the overall study population; subgroup findings are discussed in the narrative.
Outcomes are classified as “beneficial or equivalent” rather than “null” in our table if a better or equivalent outcome between the treatment and control groups was achieved and was considered a positive finding based on the theory of change hypothesized in a study. For example, if a study sought to examine the hypothesis that paid sick leave policies may produce detrimental economic outcomes (e.g., reductions in wages) but the study found equivalent outcomes between states with and without such a policy, that would be considered a “beneficial or equivalent” outcome. On the other hand, if a study sought to examine whether paid sick leave mandates produce better outcomes than states without such a policy, such as in the realm of adult health, but the study found that the policy failed to do so, then the finding is classified in our table as “null” rather than “beneficial or equivalent.” The Evidence of Effectiveness table also includes our conclusions about the overall impact on each studied policy goal. The assessment of the overall impact for each studied policy goal weighs the timing of publication and relative strength of each study, as well as the size and direction of all measured indicators.
Of the 11 causal studies included in this review, only one (Study C) examined how outcomes differed by race or ethnicity (beyond simply presenting summary statistics or controlling for race/ethnicity). Where available, this review presents the analyses’ causal findings for subgroups by race/ethnicity and gender. A rigorous evaluation of a policy’s effectiveness should consider whether the policy has equitable impacts and should assess the extent to which a policy reduces or exacerbates pre-existing disparities in economic and social wellbeing.
Table 2: Evidence of Effectiveness for Paid Sick Leave by Policy Goal
|Policy Goal||Indicator||Beneficial or Equivalent Impacts||Null Impacts||Detrimental Impacts||Overall Impact on Goal|
|Access to Needed Services||Leave-Taking||C, D||Positive|
|Access to Paid Sick Days||C, D, F|
|Use of Preventive Services / Primary Care||B, K|
|Parents' Ability to Work||Labor Force Participation||G||Positive|
|Labor Force Participation||G|
|Aggregate Leave-Taking Rateiii||H|
|Sufficient Household Resources||Wages (Weekly)||I||Trending* Positive|
|Parental Health and Emotional Wellbeing||Flu-Like Illness||E, J||Mostly Positive|
|Pneumonia- and Influenza-Related Mortality||E|
|Occupational Injury and Illness||A|
*Trending indicates that the evidence is from fewer than two strong causal studies or multiple studies that include only one location, author, or data set.
Access to Needed Services
Three studies found that paid sick leave mandates increased access to paid sick days.C,D,F One of the studies found that state-level mandates increased employee coverage rates by 13 percentage points (from a baseline of 66% of employees having access to paid sick leave) in the 4 years following passage.D A study of Washington’s paid sick leave policy found that access to paid sick leave increased by 28 percentage points compared to control states after the mandate passed.F
A recent study using data from 2005 through 2018 compared urban counties with and without paid sick leave mandates and found that mandates increased coverage by 20 percentage points (or 45%) for private sector workers.C A subgroup analysis found that women saw a greater gain than men in paid sick leave coverage after state mandates were implemented (a 10.9 percentage point increase compared to an 8.9 percentage point increase), and non-White and Hispanic workers saw a greater increase in coverage than White and non-Hispanic workers (11.4 percentage points compared to 8 percentage points).C
Two of the studies found that paid sick leave mandates result in a clear increase in leave-taking.C,D A multi-state study, using data from 2009 through 2017, found an increase in leave-taking of approximately 2 additional sick days per year among newly covered employees after the mandate’s implementation.D Another study found that mandates increased the likelihood of newly covered employees using a sick day for themselves or a family member by approximately 3.4 percentage points compared to employees with a high likelihood of pre-mandate coverage.C
A recent study of Connecticut’s paid sick leave law, passed in 2012, found that the use of preventive services increased significantly after the mandate’s implementation.B The authors used data from 2007 through 2018 and compared the use of preventive services before and after 2012 and as compared to other New England states, and determined that paid sick leave boosted the rate of wellness checkups by 2.7 percentage points, influenza vaccinations by 2.1 percentage points, dental visits by 2.3 percentage points, and Pap tests by 2.6 percentage points for workers ages 18 to 64. Results for mammograms and breast examinations were positive, but not statistically significant.B
Another study, using data from 2011 through 2017, examined the impact of New York City’s paid sick leave mandate (enacted in 2014) and found that the law led to a significant, small increase (2.5% or 0.12 percentage points) in annual primary care visits.K The authors expected that the law would allow individuals to access more timely preventive care and reduce emergency care utilization, and the study’s results corroborated that hypothesis (see the Parental Health section of this review for the effects on emergency care).
Parents’ Ability to Work
A study using data from 2005 to 2018 examined the impact of paid sick leave laws on reducing presenteeism, or working while ill.C Previous research suggests that approximately 3 million workers go to the office or workplace while sick each week, largely because of financial need.22 The study found no significant decrease in presenteeism in the sample (which included California, Connecticut, the District of Columbia, Maryland, Massachusetts, New Jersey, Oregon, Rhode Island, Vermont, and Washington). However, a study using data from 2016 through 2018 found a significant decrease of 8 percentage points for presenteeism in Washington.F
A study using data from 2006 through 2015 examined the extent to which paid sick leave mandates decrease the overall rate of leave-taking from work as a result of illness.H If workers can stay home and recover when sick without losing income, they may be less likely to need to take additional time off from work. They may also be healthier and therefore more productive when they return to work. The study compared Connecticut and the District of Columbia, the earliest adopters of such mandates, to all other states as a synthetic control group. The authors found that the policies decreased “aggregate work absences due to illness by up to 0.4 percentage points” or an 18 percent decrease from the average rate in the US (p. 227).H
Because of concerns that paid sick leave mandates may negatively impact the labor market by causing employers to decrease hiring or work hours offered as a result of the perceived additional costs of paid sick leave benefits, null impacts on employment and labor force participation may be considered a positive outcome.G Two studies found null outcomes for employment.G,I A study on the labor market effects of paid sick leave mandates used data from 2001 through 2016 and found no evidence that employment significantly decreased or increased post-mandate (the study found a 2% employment decrease that was not statistically significant).I A study of Connecticut’s paid sick leave law, using data from 2009 through 2012, evaluated the effect of the mandate on labor force participation, employment, and hours worked.G The results were not statistically significant.G
One study of employer-based policies (rather than state mandates) found that paid sick leave reduced job separation, including job-to-job turnover as well as job-to-unemployment transitions.17 The study found that paid sick leave decreased the probability of job separation within a 5-month period by 2.5 percentage points, or 25 percent.17 When the authors predicted job separation over a 2-year period, the results showed a 5.2 percentage point (or 19%) decline in job separation. A subgroup analysis within that study found that the effect of paid sick leave on reducing job separation was greater for workers without paid vacation, parents, and mothers compared to workers with paid vacation, nonparents, and fathers. The coefficient estimate was only significant for mothers and was three times larger for mothers than fathers.17
Sufficient Household Resources
Some economists have predicted that employers will reduce wages in response to increased benefit costs because of paid sick leave mandates. However, one quasi-experimental study of the US labor market effects of paid sick leave mandates did not find significant evidence that wages substantially decreased (or increased) after the enactment of such policies.I The study found wage decreases of approximately 3 percent that were not statistically significant. A finding of stable wages in this case reflects a positive outcome because it may indicate that employers are not passing on the cost of the new benefit to employees by reducing their wages.
Parental Health and Emotional Wellbeing
Overall, the research finds mostly positive impacts of paid sick leave mandates on workers’ health and wellbeing. Three studies found decreases in the rates of illness for workers after the enactment of paid sick leave laws.A,E,J The studies focused on workers, some of whom may be parents, but more research is needed that focuses specifically on parental health. A Connecticut study found that the rate of occupational injuries and illnesses decreased by 17.8 percent within occupations covered by the paid sick leave law, compared to a 6.8 percent decline in other occupations.A This rate is compared with a 12.9 percent decline in the service industry in New York, which did not have a paid sick leave policy at the time of the study, and the US overall, which saw a decline of 7.8 percent.A A study using data from 2010 through 2018, and focusing on positive health externalities, found that state paid sick leave mandates decreased influenza-like illness by an average of 28 percent within covered states for the post-mandate period studied (which varied by state, up to 3 years in some cases).E From a baseline rate of 1.9 confirmed cases per 100 patients, this finding represents a decrease of 0.53 cases per 100 patients. In just the first year post-mandate, the effect is approximately an 11 percent decrease overall relative to control states. The study also examined the impacts of paid sick leave mandates on rates of pneumonia and influenza mortality but found null results.
A study examining New York City’s paid sick leave law (using data from 2011 through 2017) found that the mandate reduced the likelihood of needing emergency department care by 1.2 percent (or 0.6 percentage points) and reduced per-person annual emergency visits by 2.5 percent or (0.02 percentage points).K This result suggests that paid sick time can provide individuals with more flexibility and time to access preventive health care, and therefore may reduce the occurrence of acute illnesses or health crises requiring an emergency department visit.
Paid sick leave laws have become increasingly critical as the COVID-19 pandemic continues to pose challenges for workers’ health. A 2020 study on the effect of the emergency sick leave provision of the federal Families First Coronavirus Response Act (FFCRA) found that states where workers gained new access to paid sick leave saw a 56 percent decrease in COVID-19 cases post-FFCRA compared with states that already had statewide access to paid sick leave (400 fewer confirmed cases per day).J
Finally, one study found null impacts of paid sick leave policies on work-life conflict.F The study measured this challenge in terms of whether employees reported having enough ﬂexibility in their schedules to deal with personal and family matters and whether the respondent’s work schedule caused stress to themselves or their family.F The outcomes for reducing work-life conflict were in the beneficial direction but not statistically signiﬁcant.
Optimal Child Health and Development
No strong causal studies were identified that examined child health outcomes as a result of state paid sick leave laws. However, one widely cited study found positive associations between paid sick leave and use of health care services for children.7 Because this study relied on cross-sectional surveys with no time distinction between treatment and outcome, the analysis did not meet our standards for causal evidence. However, the study’s findings suggest a correlation between children with parental access to paid sick leave and improved preventive care. Children with parental access to paid sick leave were 12.5 percent more likely to receive flu vaccinations and 13.2 percent more likely to receive annual medical checkups than children whose parents lacked paid sick leave.7 The study also found that access to paid sick leave was associated with a 13.3 percent decrease in the odds of delaying medical care and a 53.6 percent decrease in the odds of an emergency room visit.7
A second correlational study found that children whose parents had access to paid sick leave were 27 percent more likely to have had a doctor’s visit in the past 12 months than their peers whose parents did not have access to paid leave.16 This result is promising and suggests the need for further causal research to explore the relationship between paid sick leave mandates and children’s health. Parents without access to paid sick leave may delay a child’s care when doctors’ office hours do not align with parents’ hours off of work.
- An impact is considered statistically significant if p≤0.05. Results with p-values above this threshold are considered null or nonsignificant.
- This indicator differs from the indicator of “Leave-Taking” in the Access to Needed Services goal because it represents a beneficial reduction in missed work time in the aggregate, rather than greater access to leave-taking as needed on an individual basis.
- Presenteeism refers to working while sick.