Soumitra S Bhuyan1, Yang Wang2, Jay Bhatt3, S Edward Dismuke4, Erik L Carlton4, Dan Gentry4, Chad LaGrange5, Cyril F Chang6. 1. Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152; Methodist Le Bonheur Center for Healthcare Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN 38152. Electronic address: sbhuyan@memphis.edu. 2. Department of Health Services Research, Administration and Policy, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198. 3. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611; Illinois Hospital Associations, Warrenville Rd, Naperville, IL 60563. 4. Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152. 5. Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198. 6. Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152; Methodist Le Bonheur Center for Healthcare Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN 38152.
Abstract
CONTEXT: The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. OBJECTIVE: This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. STUDY SAMPLE: We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. RESULTS: Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). DISCUSSION: Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave.
CONTEXT: The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. OBJECTIVE: This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. STUDY SAMPLE: We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. RESULTS: Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). DISCUSSION: Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave.
Authors: Randy Albelda; Emily Wiemers; Theresa Hahn; Nandita Khera; Diana Y Salas Coronado; Gregory A Abel Journal: Qual Life Res Date: 2019-04-27 Impact factor: 4.147