The core role of sickness benefits and employer-provided sick pay is to support workers during a temporary sickness spell. By doing so, sickness benefits and paid sick leave prevent workers from facing a dismal dilemma between going to work sick or losing income and, in the worst case, even their job. Sickness benefits and paid sick leave supports workers in three ways:
They help to protect workers’ jobs, by keeping employment relationships intact during a sickness spell. Public sickness benefits and employer-provided sick pay automatically provide some form of employment protection for workers in case of sickness.
They help to protect workers’ income, in the form of employer-provided sick pay (continued wage payments by the employer) or sickness benefits (paid through taxes or social insurance). Lack of sickness benefits or paid sick leave deprives sick workers of income needed for necessities – an amount that adds up quickly for a persistent sickness (Box 2.1). Service-sector workers experiencing sickness with access to social protection in the United States report less difficulty making ends meet, less hunger and utility payment hardship and better sleep quality as a result of improved economic security compared to their colleagues with similar health needs but without any sickness-related social protection (Goodman and Schneider, 2021[3]).
They help to protect workers’ health, by allowing sick workers to recover at home rather than to continue going to work. Going to work sick reduces the time and energy to rest and recover. This can exacerbate existing health problems, augment stress, and increase the risk of subsequent sickness and absence. Moreover, not going to work sick reduces the time to use medical care. An estimated three million employees go to work sick every week in the United States (Susser and Ziebarth, 2016[4]). Sick employees without social protection forgo medical care three times more often for themselves and almost twice as often for their family compared to their peers covered by sickness benefits or paid sick leave in the United States, with higher rates still for lower-income households (DeRigne, Stoddard-Dare and Quinn, 2016[5]; Skagen and Collins, 2016[6]).1
A second role of sickness benefits and employer-provided sick pay is to protect workplaces, societies, and economies by reducing the spread of contagious diseases. Social protection for sick workers facilitates workers with a contagious disease (such as a cold) to stay at home, avoiding infections at work, or on their way to work, as collateral damage. Empirical results shows that access to sickness benefits and employer-provided sick pay reduces so-called presenteeism, i.e. workers going to work sick, by 5-15 percentage points (Callison and Pesko, 2020[7]; Schneider, Harknett and Vivas-Portillo, 2021[8]; Schneider, 2020[9]; DeRigne, Stoddard-Dare and Quinn, 2016[5]). The risks of infecting others are particularly large at the workplace where a large part of the day is spent, often in proximity with colleagues. The health of those vulnerable to sickness, such as persons with pre-existing health problems, elderly and children, is particularly put at risk (Webster et al., 2019[10]; OECD, 2020[11]).