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 Very limited research, until the past decade, has examined how state mandated paid sick leave affects access to leave-taking and employee health outcomes. More strong causal studies are needed to show the impact of paid sick leave on access to well-visits and potential health outcomes for parents and children. Because 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. Additionally, many of the studies relied on surveys that gathered self-reported data, which may lead to inaccuracies if respondents do not remember details clearly.
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 below displays the findings associated with paid sick leave (beneficial or equivalent, null, or detrimental) for each of the strong studies (A through J) in the causal studies reference list, as well as our conclusions about the overall impact on each studied policy goal.
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 an expected outcome in the study’s hypothesis. For example, if the mandate of paid sick leave was hypothesized to produce detrimental outcomes (e.g., on wages) but a study found equivalent outcomes to states without a mandate of paid sick leave, that would be considered a “beneficial or equivalent” outcome. On the other hand, if a paid sick leave mandate was intended to produce better outcomes than states without a paid sick leave but failed to do so, then the finding is classified in our table as “null” rather than “beneficial or equivalent.” 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.
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 Days||C, D, F|
|Parents' Ability to Work||Labor Force Participation||G||Positive|
|Job Separation (includes job-to-job and job-to-nonemployment)||B|
|Illness-Related Leave-Taking Rate||H|
|Reduced Presenteeism |
(Working While Sick)
|Worked the Past Week||G|
|Sufficient Household Resources||Wages (Weekly)||I||Trending Positive^|
|Parental Health and Emotional Wellbeing||Rates of Flu-Like Illness||E, J||Positive|
|Rates of Occupational Injury and Illness||A|
|Stress from Work-Life Conflict||F|
^ 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 (Leave-Taking)
Because many paid sick leave mandates have exemptions for small businesses and specific industries, research has evaluated whether mandates affect coverage rates of paid sick leave benefits. Three studies found that paid sick leave mandates increased access to paid sick days.C,D,F A 2020 study found that state-level mandates increased coverage rates of employees by 13 percentage points (from a baseline of 66 percent) in the 4 years following passage.D A 2020 Washington study found coverage increased 28 percentage points compared to control states.F A 2020 study that focused on state and local paid sick leave policies compared urban counties with and without mandates and found that mandates increased access by more than 8 percentage points in the treatment counties compared to counties where no mandate existed.C
Because workers must earn and accrue sick time before they can take it, use of earned days increases linearly in the years post-mandate.D Three studies found paid sick leave mandates result in a clear increase in leave-taking. The 2020 multi-state mandate study found an increase in leave-taking of approximately 2 additional sick days per year.D The Washington study found that post-mandate the likelihood of workers working while sick decreased by 8 percentage points compared to control states.F A 2020 study found 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
Parents’ Ability to Work
One study found that paid sick leave reduced job separation, including job-to-job turnover as well as job-to-unemployment. A 2013 study of employer-based (not mandated) policies found that paid sick leave decreased the probability of job separation by 2.5 percentage points.B A subgroup analysis within that study found that the effect of paid sick leave on reducing job separation is 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 three times larger for mothers than fathers.B
Because of fears that paid sick leave mandates may negatively impact the labor market by causing employers to decrease hiring or work hours offered,G null impacts on employment may be considered a positive outcome. Two studies found null outcomes for employment. A 2020 study on the labor market effects of paid sick leave mandates found no evidence that employment significantly decreased or increased post-mandate.I A 2015 study of Connecticut’s paid sick leave law evaluated the effect of the mandate on labor force participation, employment, and hours worked. Once adjusted for controls, the results were statistically insignificant.G
Sufficient Household Resources
Some economists have predicted employers will decrease wages in response to increased benefit costs because of paid sick leave mandates. However, one multi-city and state 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 paid sick leave mandates.I Wage decreases of 3 percent or greater (the amount estimated to offset the costs of the new benefits) in jurisdictions post-mandate were statistically insignificant.I A lack of change in wages in this case is a positive outcome because employers are not passing on the cost of the new benefit to employees by decreasing wages.
Parental Health and Emotional Wellbeing
Three studies found decreases in rates of illness for workers after enactment of paid sick leave laws.A,E,J The research in these studies focuses on workers, some of whom are parents, but more research is needed that focuses specifically on parental health. A Connecticut study found the rate of occupational injuries and illnesses decreased by 17.8 percent within the service industry and by 6.8 percent in other occupations after the enactment of a paid sick leave mandate.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 with a decline of 7.8 percent.A A 2020 study focusing on positive health externalities found that state paid sick leave mandates decreased influenza-like illness by 28 percent.E This decrease was based on a baseline rate of 1.9 confirmed cases per 100 patients that decreased by 0.53 cases per 100 patients. 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 newly gained access to paid sick leave saw a 56 percent decrease in COVID-19 cases post-FFCRA compared with states that already had access to paid sick leave.J
One study found null impacts of paid sick leave policies on work-life conflict. The study measured work-life conflict in three ways: employees having enough ﬂexibility in their schedules to deal with personal and family matters, if the respondent’s work schedule caused stress to themselves or their family, and the combination of those two responses.F These variables most closely capture the dimension of work–life conﬂict that paid sick leave might help to mitigate. The outcomes were in the positive direction but not statistically signiﬁcant.
Optimal Child Health and Development
No strong, causal studies were identified that examined child health outcomes. 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, it did not meet our standards for causal evidence. However, it does 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
Parents without access to paid sick leave may delay a child’s care when doctor’s office operating hours do not align with the parent’s hours off work. The correlational study found access to paid sick leave decreased the odds of delaying medical care because of a time mismatch by 13.3 percent and lowered the odds of an emergency room visit by 53.6 percent.7