title: Paid sick leave is associated with fewer ED visits among US private sector working adults.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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: 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.
authors: Soumitra S
authors: SS
authors: Bhuyan
authors: Department of Health Services Research, Administration and Policy, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198.
authors: Yang
authors: Y
authors: Wang
authors: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611; Illinois Hospital Associations, Warrenville Rd, Naperville, IL 60563.
authors: Jay
authors: J
authors: Bhatt
authors: Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152.
authors: S Edward
authors: SE
authors: Dismuke
authors: Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152.
authors: Erik L
authors: EL
authors: Carlton
authors: Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN 38152.
authors: Dan
authors: D
authors: Gentry
authors: Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198.
authors: Chad
authors: C
authors: LaGrange
authors: 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.
authors: Cyril F
authors: CF
authors: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017149:Private Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult