Researchers in Health Affairs report that employees who had access to sick leave and more job flexibility were more likely to say that they had access to healthcare and at least one office visit to a medical professional in the previous year. Researchers used data from 2017 – 2019, before the pandemic. They calculated healthcare access and use by linking data from two federal surveys. One characterizes job flexibility and sick leave; the other asks respondents to report on their medical care.
The pandemic led to increased access to sick leave among hourly workers, although some companies decreased sick leave after the initial waves of COVID-19. Employees in the U.S. continue to be less likely to have sick leave than workers in other developed countries, most of which require sick leave by law.
Implications for employers:
Kaiser Health News and National Public Radio report that there are 100 million Americans facing medical debt, and about two-thirds of them report they have put off care for themselves or family members because of cost. A quarter of those with medical debt owe more than $5,000. One in five with medical debt reported they thought they would never be able to pay off the debt.
Medical debt was more common but not limited to those with low income (68% among those earning under $40,000, and 45% of those earning over $90,000). Medical debt was more common for Black (69%) and Hispanic people (64%), but the majority of white people also reported medical debt (54%). Medical debt was more common for the uninsured (71%), but pretty common for those who were insured as well (61%).
A previous analysis by the Consumer Financial Protection Bureau showed that 58% of debts in collection were related to medical care.
Implications for employers:
JAMA Network Open researchers evaluated average survival times of over 220,000 diagnosed with various Stage IV (widely metastatic) cancers between 2016 and 2018 using the National Cancer Database. They found that those with private insurance on average fared far better than those who were uninsured. The researchers adjusted survival times for age and poverty. They also found that those with commercial insurance had longer survival times than those with Medicare or Medicaid. This likely represents genuine longer survival, although there could be some element of earlier diagnosis of metastatic cancer in those with private insurance.
Implications for employers:
The Centers for Disease Control and Prevention (CDC) reported that while there are more antiviral distribution sites in ZIP codes with higher social vulnerability (lower income and more chronic illness), those who live in high vulnerability ZIP codes are only half as likely to be prescribed oral COVID-19 antiviral medications. This is important because antivirals decrease hospitalization and death especially in high-risk individuals, and may also decrease transmission and the risk of long COVID.
Getting an antiviral prescription requires getting a timely test, a timely provider appointment, and a pharmacy to dispense the medication. “Test to treat” approaches could allow expedited treatment. Currently, test to treat only applies to pharmacies with nurse practitioners or physician assistants onsite. This approach would be far more effective if we allowed pharmacists to evaluate patients and dispense antiviral drugs on the spot.
Implications for employers:
I have COVID-19.
I likely contracted the virus on a weekend gathering at a house with friends. We all did rapid antigen tests before arriving, and no one had symptoms over the four-day weekend. I developed a sore throat, cough and mild fever on Monday night. So far, four of the nine who were at that house have tested positive. Two others had COVID-19 in the previous two months, so they likely had some additional protection.
I have a sore throat, cough and fatigue, but my symptoms are mild. Full vaccination and two boosters have made it less likely that I will have disease beyond my upper respiratory system, although there is no guarantee. I am taking Paxlovid and isolating to keep from infecting others, especially my wife. I’m lucky to be a patient of a medical group that provided a telemedicine visit within five hours of my request, and I live in a community where the local pharmacy has stocked Paxlovid.
In retrospect, we probably should have continued to test after we arrived, and we should have avoided the two evening indoor restaurant dinners. But there is no absolute way to avoid all exposure to COVID-19, and the BA.4 and BA.5 strains are especially good at evading immunity from both vaccinations and previous infections. Assuming I am feeling well and no longer infectious and my wife doesn’t get infected, I’ll be flying to a national park at the end of the month for a vacation – and I have no hesitation about embarking on this trip. My wife and I will both wear masks a lot, even if we are the only people doing so.
Over a third of the U.S. population had not had a COVID-19 infection as of February based on CDC tests of blood drawn at commercial laboratories for other reasons. I’m happy that I got this infection later, when good treatments are available, and our understanding of the disease has improved. I have no regret about being the only one in many rooms with a mask over the last months; otherwise, I might have been infected earlier, or I might have been infected with a higher dose of viral particles, which could have led to more serious disease.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
