Paid Sick Leave Improves Preventive Screening Rates by Up to 8%

A new study out of Tulane University confirms what many may have been able to guess about patient access to care: paid sick leave policies increase preventive screening rates because they give patients the time to actually visit the doctor.

The study, published in the New England Journal of Medicine, found that paid sick leave policies were linked with a 4 percent increase in breast cancer screening rates and a 6 to 8 percent increase in colorectal screening rates. Unsurprisingly, there were some racial health disparities apparent, as Black and Hispanic workers tend to lack paid sick leave benefits.

The high cost of healthcare, especially for those without insurance, tends to be singled out as the biggest patient care access barrier. But according to the researchers, there are other roadblocks keeping patients from getting their preventive screenings, like getting paid time off work.

“These non-monetary barriers to healthcare access matter,” Kevin Callison, lead author and assistant professor of health policy and management at Tulane’s School of Public Health and Tropical Medicine and The Murphy Institute, said in a statement. “Improving or reducing these barriers can have meaningful impacts on people’s health.”

Citing figures from the US Bureau of Labor Statistics, around a quarter of American workers cannot take a paid sick day, and that could be having a negative impact on preventive screening rates that are already abysmal.

The team looked at changes in breast and colorectal screening rates from among 2 million employees from between 2012 and 2019, a timeframe during which the researchers said many states and municipalities adopted paid sick leave mandates. Across the entire study population, people worked in 300 metropolitan areas and were exposed to 61 different paid sick leave policies.

Overall, having some sort of access to paid sick leave was associated with a 4 percent increase in breast cancer screening rates and a 6 to 8 percent increase in colorectal screening rates.

The research team acknowledged that those increases sound small. However, the analysis included folks who already had access to paid sick time, so they would have little impact on any observed increase or decrease in cancer screening rates, they said.

“Our effects become much larger if we're willing to assume that only the workers who are gaining paid sick leave coverage are the ones who are changing their screening behaviors,” Callison explained.

If the study only included workers who gained paid sick time during the study period, the researchers estimated increases would be in the 9 to 12 percent range for breast cancer screenings and 21 to 29 percent increase range for colorectal cancer screenings.

By looking more at policy change than individual behavior change, the researchers said they were able to more realistically outline the impact access to paid sick leave can have. Moving forward, it may be valuable to examine the link between paid sick time, cancer screening access, and early detection and subsequent outcomes of illness.

There could be some racial disparities at play here, the researchers added as a caveat. Most of the people without access to paid sick leave are Black or Hispanic and they have lower-incomes.

“We know that racial and ethnic minorities tend to have higher mortality rates for certain cancers,” Callison said. “So are things like this going to improve those gaps? That’s really the next step where we want to go.”

These findings corroborate similar study results. In June 2022, researchers wrote in Health Affairs that access to paid sick leave can increase the odds of a clinic visit by 3.83 percentage points. Another study showed that paid sick leave increased the rate at which patients received vaccinations by 17 percent.

These findings come as the US grapples with changes in preventive screening rates in light of the pandemic. Following the outbreak of COVID-19, researchers clocked significant decreases in preventive care access, mostly due to closures in non-emergency care at the start of the emergency and also because of fear of contracting the virus and cost barriers.