摘要：Objectives. We examined employers’ responses to San Francisco, California’s 2007 Paid Sick Leave Ordinance. Methods. We used the 2009 Bay Area Employer Health Benefits Survey to describe sick leave policy changes and the policy’s effects on firm (n = 699) operations. Results. The proportion of firms offering paid sick leave in San Francisco grew from 73% in 2006 to 91% in 2009, with large firms (99%) more likely to offer sick leave than are small firms (86%) in 2009. Most firms (57%) did not make any changes to their sick leave policy, although 17% made a major change to sick leave policy to comply with the law. Firms beginning to offer sick leave reported reductions in other benefits (39%), worse profitability (32%), and increases in prices (18%) but better employee morale (17%) and high support for the policy (71%). Many employers (58%) reported some difficulty understanding legal requirements, complying administratively, or reassigning work responsibilities. Conclusions. There was a substantial increase in paid sick leave coverage after the mandate. Employers reported some difficulties in complying with the law but supported the policy overall. The Bureau of Labor Statistics estimates that in 2009 only 61% of workers nationwide in private industry had access to paid sick leave, with part-time (26%) and low-wage (33%) workers less likely to report access. 1 There are health benefits to be gained by the adoption of a paid sick leave policy: reducing spread of influenza and infectious diseases in the workplace and childcare facilities 2–4 and allowing workers to visit physicians, which may reduce unnecessary hospitalization and subsequent sickness absence. 5 Previous research shows that the availability of paid sick leave is associated with increases in workers using sick leave, reductions in presenteeism (workers being on the job while sick), decreases in job loss because of sickness, and increases in the ability to care for sick children. 6–20 Workers benefit from the insurance against loss of income or employment, and there may be economic benefits for employers, such as reducing job turnover and limiting productivity decreases because of presenteeism. 21 However, mandated benefits may have detrimental effects on wages, employment, and business profitability. 22,23 In recent years, San Francisco, California, has been at the forefront of worker protection, implementing a citywide minimum wage requirement in 2004, 24 mandatory paid sick leave in 2007, 25 and an employer health benefit mandate in 2008. 26 On February 5, 2007, San Francisco became the first jurisdiction to enact a policy 25 ; recently, Connecticut 27 ; New York City 28 ; Portland, Oregon 29 ; Seattle, Washington 30 ; and Washington, DC 31 passed laws requiring paid sick leave, and many other jurisdictions are considering similar policies. 32 The San Francisco Paid Sick Leave Ordinance (PSLO) requires employers to provide paid sick leave to all employees (including part time and temporary). Paid sick leave must accrue at a rate of 1 hour for every 30 hours worked after the first 90 calendar days of employment. 33 Enforcement is complaint driven, and the Office of Labor Standards Enforcement receives an average of 4 complaints a month. 34 A small study (n = 26) 1 year after the PSLO went into effect found that San Francisco employers reported little benefit from reduced absenteeism, lower turnover, or improved morale and little impact on profitability. 35 There is growing momentum for paid sick leave requirements across the United States 32 but little evidence to inform us of their effects on employers, employees, or customers over the longer term. 36 We examined the 2009 Bay Area Employer Health Benefits Survey data to report changes employers made to comply with the sick leave mandate and the types of firms that made the greatest changes to sick leave policies. We analyzed the types of policies firms offer, employer-reported changes in other benefits, employee morale, prices, profitability, presenteeism, and absenteeism associated with changes in sick leave policy. We investigated employer sentiment, including support for the mandate and difficulties with implementation. We sought to inform policymakers about the impact of the PSLO on employers in San Francisco and allow policymakers in other cities or states considering similar legislation to assess the likely effects of such a policy.
