State Mandatory Paid Sick Leave Associated With A Decline In Emergency Department Use In The US, 2011-19

Health Aff (Millwood). 2022 Aug;41(8):1169-1175. doi: 10.1377/hlthaff.2022.00098.


Paid sick leave provides workers with job-protected paid time off to address short-term illnesses or seek preventive care for themselves and their family members. We studied the impact of mandatory paid sick leave at the state level on emergency department (ED) visit rates, using all-payer, longitudinal ED data from the Healthcare Cost and Utilization Project for the period 2011-19. We found that state implementation of paid sick leave mandates was associated with a 5.6 percent reduction in the total ED visit rate relative to the baseline, equivalent to 23 fewer visits per 1,000 population per year. The reduction was concentrated in Medicaid patients. Some of the largest reductions were ED visits related to adult dental conditions, adult mental health or substance use disorders, and pediatric asthma. Mandatory paid sick leave may be an effective policy lever to reduce excess ED use and costs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Child
  • Emergency Service, Hospital
  • Employment
  • Health Care Costs
  • Humans
  • Salaries and Fringe Benefits*
  • Sick Leave*
  • United States