Employers will often choose to provide paid sick leave to some of their employees. About 15 years ago, neither the US federal government nor state governments required paid sick leave, but about 63% of US employees worked in jobs that had at least paid short-term sick leave. Since then, 18 US states and lots of cities and counties have started requiring paid sick leave, and by 2023, about 77% of US employees had jobs with at least short-term paid sick leave. Stefan, Pichler Christopher Prinz, Stefan Thewissen, and Nicolas R. Ziebarth describe the evidence from the US experience, along with international comparisons and the underlhying economic tradeoffs, in “The Economics of Paid Sick Leave” (Journal of Economic Perspectives, Spring 2026, 40:2, 215–42. I work as Managing Editor of the JEP.)
Before the rise of US state and local government mandates for paid sick leave, the benefit was not distributed equally across the workforce. The authors write:
In 2011, based on calculations from the National Compensation Survey by the Bureau of Labor Statistics, 63 percent of all US jobs came with (voluntary) paid sick leave provision for short-term sickness. However, heterogeneity by job type was substantial: 76 percent of full-time employees but only 28 percent of part-time employees had paid sick leave coverage. Further, private-sector employees in large firms with more than 100 employees were more likely to be covered by paid sick leave than those in firms with fewer than 100 employees (74 percent versus 54 percent). Unionized jobs had a higher probability of coming with paid sick leave than nonunionized jobs (72 percent versus 63 percent). Notably, the income gradient was steep: only 33 percent of jobs in the bottom quartile of the wage distribution offered paid sick leave, compared with 86 percent in the top quartile.
Even in a situation without government requirements, employers have two main reasons for providing paid sick leave: it can help to attract certain kinds of employees (if the employees place a high value on paid sick leave), and it can discourage sick employees from coming to the office and infecting other workers. To put it another way, sick leave for some can lead to less need for sick leave by others. On the other side of the tradeoff, paid sick leave raises the possibility that workers will use it for an extra day off, now and then. In particular, firms may be concerned that if they offer a paid sick leave benefit, while other firms do not, they are more likely to attract employees with a greater likelihood of being sick.
In an effort to balance these concerns, countries have different rules about paid sick leave, as shown in the table. For example, a number of countries require being sick and staying home for several days before you can claim paid sick leave. A number of countries require a doctor’s note to verify the sickness. The “paid” part of paid sick leave can be 100% of normal pay, or less, and it can either be paid by the employer, or paid by an insurance fund into which the employer has already paid. Most countries have a line between short-term and long-term paid sick leave, with the amount received by the sick worker being reduced when the long-term category is reached.

Paid sick leave in the US (and Australia) operates differently than in most other countries. The standard design for sick leave policies in the US has the employee build up credits for sick leave over time, and then use those credits when claiming sick leave. (A common rule is to accumulate one hour of sick leave credits for every 40 hours worked.) This approach has the advantage that a sick employee is, in a way, spending their own resources from their own personal account. It also protects employers against hiring someone who, soon after being hired, starts taking extensive sick leave for which the employer has to pay.
In contrast, most other countries have a social insurance fund for the costs of paid sick leave: a standad pattern is that employers pay into the fund for short-term leave and general tax revenues covers long-term sick leave.
The overall challenge for design of paid sick leave, as the authors write, is to minimize “inefficient absenteeism,” when workers are out of the workplace with paid sick leave and don’t really need to be, and “inefficient presenteeism,” where sick workers come to the office even though their productivity may be quite low and they have a risk of infecting others. As the authors point out, there isn’t a consensus on the best constellation of rules for defining paid sick leave; for example, requiring employees to take a few unpaid days of sick leave before claiming sick leave is intended to discourage overly casual use of paid sick leave, bu tin practice, ti can lead to the worker being out of the office longer–after the sick leave payment kicks in.
But it’s interesting to note variations across countries in the amount of sick leave that is claimed. Say that a worker spends 240 days/year at the workplace (five days per week, but with some holidays and vacation). Thus, a sick leave rate of 1% per year means the average employee misses 2.4 days/year of work; a sick leave of 4% means that the average employee is missing about two weeks of work each year.

Comparing large economies at the extremes these sick leave rates, the authors write: “Thus, when employees have no access to paid sick leave, as continues to hold true in many states and professions in the United States, many employees will work sick and the costs of presenteeism will be high as workers spread contagious diseases and have low work productivity. On the other hand, a generous sick leave system like Germany’s, where employer mandates require a 100 percent replacement rate for up to six weeks per sickness episode, leads not only to high employer costs, but also to an inefficiently high share of workers who call in sick, thereby raising the costs of absenteeism.”










