Researchers analyzed data from a nationally representative sample of U.S. workers responding to the Medical Expenditure Panel Survey–Household Component from 2017 to 2019, combined with occupational data from the Occupational Information Network database.

Results demonstrated that receiving paid sick leave as an employee benefit was positively associated with health-care access and use, a finding consistent with those of several earlier studies. The results highlight the importance of differences in how work is organized across a large variety of occupations for workers' ability to access and use health care.

Informal features of work environments are important. They reflect whether workers have the day-to-day autonomy to take breaks and structure their workdays to accommodate the need for leave of varying kinds, and they also likely affect the practical feasibility of using employee benefits such as paid sick leave.

Although policy interventions to improve the degree of informal flexibility that workers are offered by their jobs likely are difficult to implement in many contexts, there are a number of potentially promising recent efforts to do so through policies that directly address predictive scheduling.

Beyond the public policy context, employers concerned for the health and well-being of their workers may choose voluntarily to offer workers greater flexibility. Health-care providers may be able to better accommodate workers with inflexible jobs by taking a number of actions, such as reducing wait times, improving the predictability of visit time lengths and offering appointments outside of standard work hours.

Aside from the implications for health-care access and use disparities among people with varying occupations, researchers also documented racial and ethnic disparities, as well as income disparities in job flexibility. Low-income people were less likely to have flexibility. Hispanic or Latino and Black men, on average, had the least flexible jobs of all racial and ethnic sex subgroups.

Black and Hispanic or Latino workers also were less likely than white and Asian workers to have paid sick leave. Low job flexibility is a risk factor for poor health, and low flexibility makes it harder to access health care.

Results suggest that variations in job characteristics, including access to paid sick leave as an employee benefit and informal structural aspects of job flexibility, may generate racial and ethnic disparities as well as income disparities in health-care access and use.

"Difficulty navigating the work environment to obtain time off as needed to seek medical care is a significant source of health inequity in the United States and a likely contributor to racial and ethnic as well as income disparities in health-care access and use," the study concluded. "Public policies that improve workplace flexibility and increase access to paid sick leave are likely to improve health-care access and use while reducing disparities.

"Voluntary efforts by employers to offer more flexibility to their workers and reforms by health-care providers to better accommodate people with inflexible jobs likewise could help advance these outcomes and increase access to paid sick leave are likely to improve health-care access and use while reducing disparities."