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Employer-provided sick leave and job flexibility increase healthcare access and use

By Jeff Levin-Scherz, MD, MBA | June 29, 2022

Providing employees paid time off for illness can decrease workplace spread of infection and boost recruitment and retention rates.
Health and Benefits|Benessere integrato
Risque de pandémie

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:

  • Sick leave makes employees less likely to come to work with a transmissible illness and can help with recruitment and retention by showing the company’s concern for employee welfare.
  • Sick leave can also decrease the likelihood of business and workplace disruption from infections and quarantines for exposure.

Healthcare debt is widespread in the U.S.

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:

  • Employers can evaluate the adequacy of their health plans by projecting the percentage of employees who might face financial insecurity from the cost of medical care. High deductible health plans can leave some lower-wage workers feeling that their health insurance covers only preventive and catastrophic care.
  • The WTW 2021 Best Practices Survey showed that 22% of employers offered lower premiums to lower-wage workers (salary banding), but only 5% structure plan design based on employee pay level.

Metastatic cancer survival longer in those with insurance

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:

  • This study shows the high value of employer-sponsored health insurance.

COVID-19 antivirals less likely to be used in socially vulnerable areas

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:

  • Employers should encourage employees to get tested as soon as they have symptoms so they can potentially qualify for these oral medications, which must be started less than five days after symptoms begin.
  • Telemedicine can provide good access for evaluation and prescription of antivirals for those with COVID-19 infections, and almost all employers at this point offer a telemedicine option for their members.
  • Telemedicine has the added advantage of not exposing others in a medical setting to the risk of transmission.

On a personal note

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.

COVID-19 update

  • Reported cases of COVID-19 remain at around 100,000 per day, which understate cases substantially since most cases (including mine) are now being diagnosed by home testing. National wastewater surveillance shows a modest decline in viral particles. The CDC reports that 82% of counties have a high rate of community transmission, although only 10% of counties have a high community level, which incorporates hospital capacity.
  • Omicron strains BA.4 and BA.5 now represent about 35% of cases in the U.S. and will likely soon be dominant. These strains are exceptionally effective at evading immunity (either from vaccine or infection), making it much more likely that we will continue to face high rates of infection and reinfection over the summer.
  • Moderna announced that its bivalent COVID-19 vaccine, which was designed to protect against the original strain of COVID-19 as well as an earlier Omicron strain, induces antibodies that are highly protective against BA.4 and BA.5. This rapid development of a new vaccine composition is one of the major advantages of the messenger RNA technology used by both Moderna and Pfizer/BioNTech.
  • Data from Kaiser Permanente showed that among over 5,000 mostly vaccinated patients with newly diagnosed COVID-19 treated with Paxlovid, progression to more serious disease was quite rare. Only 39 were treated in an emergency department (0.74%) and only seven were admitted to a hospital (0.11%). This finding is especially reassuring since the initial studies of Paxlovid were limited to those who were unvaccinated.

Population Health Leader, Health and Benefits, North America

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.

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