Contagion Nation:
A Comparison of Paid Sick Day
Policies in 22 Countries
Jody Heymann, Hye Jin Rho,
John Schmitt, and Alison Earle
May 2009

Center for Economic and Policy Research
1611 Connecticut Avenue, NW, Suite 400
Washington, D.C. 20009
202-293-5380
www.cepr.net

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Contents
Executive Summary............................................................................................................................................................ 1
Introduction......................................................................................................................................................................... 2
Why Paid Sick Days and Paid Sick Leave Matter .......................................................................................................... 2
Where the US Stands in Comparison to Other Top Economies ............................................................................... 4
Beyond Federal Mandates: State and Local Policy and Voluntary Steps by Firms in the United States ............ 12
Conclusion ......................................................................................................................................................................... 16
References .......................................................................................................................................................................... 17
Appendix: Full-time Equivalent Paid Sick Days.......................................................................................................... 20

About the Authors
Jody Heymann is Founding Director of the Institute for Health and Social Policy. Hye Jin Rho is a
Research Assistant at the Center for Economic and Policy Research. John Schmitt is a Senior
Economist at the Center for Economic and Policy Research. Alison Earle is Co-Director of the
Project on Global Working Families.

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Executive Summary
We review paid-sick-day and paid-sick-leave policies in 22 countries ranked highly in terms of
economic and human development and find that the United States is the only country that does not
guarantee that workers receive paid sick days or paid sick leave. Current U.S. labor law does not
require employers to provide short-term paid sick days or longer-term paid sick leave; current U.S.
law does not even protect all workers from being fired when they miss work due to illness.1
To compare the various national policies, we calculate the employer- or government-provided
financial support available to workers facing two different illnesses requiring time off from work: a
bout of flu that requires missing five days of work and a cancer treatment that requires missing fifty
days of work. Provision of paid sick days or leave is critical to the ability of employed Americans to
take time when they or their family members are sick and to prevent the spread of influenza and
other contagious diseases. Paid sick days and leave are essential for ensuring that all Americans can
treat and address their own and their family members’ serious illnesses. A substantial body of
research has shown that in addition to the obvious health and economic costs imposed on
employees by the lack of paid sick days or leave, significant economic costs result as well for
employers. Workers who go to work while sick stay sick longer, lower their productivity as well as
that of their coworkers, and can spread their illnesses to coworkers and customers.
Only three countries – the United States, Canada, and Japan – have no national policy requiring
employers to provide paid sick days for workers who need to miss five days of work to recover from
the flu. In Canada, labor policy is a provincial jurisdiction and most provinces provide for some days
off during short-term illnesses. Eleven countries – Australia, Austria, Belgium, Denmark, Finland,
Germany, Iceland, Luxembourg, New Zealand, Norway, and Switzerland – guarantee the typical
worker full pay while recovering from a five-day illness. In the rest of the countries in our sample,
payments vary: 3.5 days pay for five missed days in Greece and the Netherlands, 3.2 days pay in
Sweden, 1.2 days in Spain, 1 day in France, 0.7 days in Ireland, and 0.4 days in the United Kingdom.
The lesser days generally reflect a waiting period for mandated coverage.
The United States is the only country that does not provide paid sick leave for a worker undergoing
a fifty-day cancer treatment. Luxembourg and Norway provide full pay for the 50 full-time
equivalent working days missed, while others provide less: Finland (47), Austria (45), Germany (44),
Belgium (39), Sweden (38), Denmark (36), Netherlands (35), Spain (33), Italy (29), Greece (29),
Japan (28), France (24), Canada (22), Ireland (17), Iceland (17), Switzerland (15), Australia (10), the
United Kingdom (10), and New Zealand (5).

1 The 1993 Family and Medical Leave Act requires a subset of employers (those with 50 or more employees) to
provide a subset of employees (those who have worked for their employer for at least 1250 hours in the 12 months
prior to the leave) with unpaid leave to address a subset of circumstances, when a close family member (limited to a
child, parent, or spouse) has a “serious health condition” (not a common illness).
See http://www.dol.gov/esa/whd/fmla/finalrule/NonMilitaryFAQs.pdf.

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Introduction
This report reviews the paid-sick-day and paid-sick-leave policies2 in 22 countries and analyzes the
effects of these policies on the rights and benefits for workers with illnesses.3 Policies covering
short-term illnesses are complicated and differ widely across the countries we examine. To simplify
our presentation of national laws, we concentrate on how national paid-sick-day and paid-sick-leave
policies affect workers in two distinct situations. We first look at a worker suffering from the flu and
who must miss five days at work and then at a worker with a more serious illness, such as cancer,
who must undergo a treatment that requires a fifty-day absence from work. Examining these two
important examples of health problems that would require time off from work allows us to assess
the adequacy of coverage for a range of health issues a worker might face.

Why Paid Sick Days and Paid Sick Leave Matter
The Health of Working Americans and Their Families
If there is no policy for taking paid time off for illnesses, many workers continue to go to work
when they are sick,4 jeopardizing their own recovery and health. Research has shown that taking
adequate time to rest and recuperate when sick encourages a faster recovery and helps prevent
minor health conditions from progressing into more serious illnesses.5
If working adults are able to stay home when they are sick, they are less likely to spread infectious
diseases to adults they work with.6 As just one example, the spread of infectious disease at the
workplace is the reason that the U.S. Centers for Disease Control and Prevention recommended
that Americans with influenza – a disease that leads to 200,000 hospitalizations and over 36,000
deaths in an average year7 – stay home when they are sick.8 Conservatively estimated, at least 20
million Americans go to work sick because of a lack of sick leave.9 With the recent outbreak of
2 We use the term “paid sick days” to refer to short-term leave for health-care appointments, to deal with short-term
illnesses and injuries, and to address periodic short-term health needs related to chronic health conditions. The term
“paid sick leave” is used to refer to longer-term medical leave such as that needed for serious health conditions that
require lengthier treatment and recovery periods. We use the term “paid sick days and leave” to refer to both of
these policies together. In many countries, paid sick days are covered by employer mandate and paid sick leave by
social insurance.
3 For a previous investigation of the economic feasibility of paid sick leave, see Earle and Heymann (2006).
4 Lovell (2004).
5 This literature is reviewed in Earle and Heymann (2006).
6 Skatun (2003), Lovell (2004).
7 Centers for Disease Control and Prevention (2006a).
8 Centers for Disease Control and Prevention (2006b).
9 There are two good sources available for estimating the number of workers who go to work when they are sick.
Twenty million represents a lower bound estimate. National data show a 15 percentage-point gap in the number of
workers who go to work sick depending on whether they reported their company provided paid sick leave. (Those
with paid sick days are less likely to go to work sick.) However, many Americans, who in theory receive paid sick
days, are still financially penalized at work and thus went to work when they were sick. In this same national survey,
11% reported they lost a job because of taking time off for illness and 11% say they or a family member have been
“fired, suspended or otherwise penalized for taking time off for illness.” (Smith, 2008). A two-state survey of adults
from Florida and Ohio asked employed adults directly whether they had gone work sick because of fears about
financial penalties. Nearly half said yes. If these figures held for the national population, it would mean over 70
million Americans are going to work sick (Silberner, 2008).

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H1N1 influenza, public health officials again are recommending that adults stay home from work
when they are sick and that children stay home from school if they have symptoms. The ability to
stay home is dramatically affected by whether the infected adult or the sick child’s parent has paid
sick days. Parents with paid sick days are five times more likely to be able to care for sick children at
home than similar parents who do not have paid sick days. Parents with paid sick days are also more
likely to provide preventive health care.10
In health care and service settings, providing paid sick days to employees also helps to protect the
health of patients and customers. For example, nursing homes that provide their employees with
paid sick days have lower rates of respiratory and gastrointestinal illness among the patients they
serve.11
Moreover, paid-sick-day policies are also important to the ability of working Americans to meet the
health needs of their children.12 Sick children have shorter recovery periods, better vital signs, and
fewer symptoms when their parents share in their care. Yet without paid sick days, parents,
especially resource-poor parents, may have little choice but to miss needed doctors’ appointments or
to have sick children stay home alone where they risk missing or improperly managing medications
and may not be able to obtain emergency help. Lack of paid sick days places not only the health of
working Americans’ own children at risk but that of other children. 13 When parents lack paid sick
days, they are far more likely to send their sick children to child care and school.14 Children sent to
day care when they are sick with contagious diseases exacerbate the higher rate of observed
infections in day-care centers, including higher rates of respiratory and gastrointestinal infections.
Finally, paid sick days and leave influence the ability of working Americans to care for their aging
parents. When sick adults receive support from family members, they have substantially better
health outcomes from conditions such as heart attacks15 and strokes.16 Elderly individuals also live
longer with family support.17,18
The Health of the Economy
Paid sick days and leave have as substantial an impact on the finances of working Americans and
their families as on their health. Without paid sick days and leave, working adults are placed at risk
economically, experiencing wage and job loss when they take time off to care for their own health or
to provide care for family members.19 Immediate economic effects are due to wage loss in the
absence of paid sick days and leave. Many households, already economically threatened, cannot
afford the one-to-two weeks of wage loss due to the wage earner’s illness and that of immediate
family members that typically occur in a given year. Long-term economic effects include the risk of
job loss. As just one example, in a study of nurses, most of whom were middle class, paid sick days
were the only benefit significantly associated with an increased likelihood of returning to work after

10
11
12
13
14
15
16
17
18
19

Heymann et al (1999).
Li et al. (1996).
This literature is summarized in detail in Heymann (2000).
These studies are described in detail in Heymann (2000).
Heymann, Vo, and Bergstrom (2002).
Bennet (1993), Gorkin et al. (1993).
Tsouna-Hadjis et al. (2000).
Seeman (2000), Berkman (1995).
These studies are described in detail in Earle and Heymann (2006).
This literature is reviewed in Heymann (2000).

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developing heart disease or having a heart attack. Nurses with paid sick days were 2.6 times more
likely to be able to return to work after a heart attack or angina.20
While companies incur some costs from providing paid sick days and supporting paid leave, they
also accrue financial benefits. Firms that provide paid sick days and leave tend to have lower job
turnover rates, lower recruitment and training costs, lower unnecessary absenteeism, and a higher
level of productivity than firms that do not offer these kinds of benefits.21 This is because individuals
who are ill cannot work at full capacity, and output and production are reduced for themselves and
their co-workers as a result of going to work sick.22 When workers don’t take time off to address
illnesses at their onset, they often end up taking longer absences as conditions worsen.23 Moreover,
when workers come to work with contagious illnesses, they spread them to co-workers, increasing
the pool of absent or low-productivity workers.

Where the US Stands in Comparison to Other Top
Economies
This Study
This study analyzes paid-sick-day and paid-sick-leave policies in the United States and 21 other
countries that are also highly ranked in terms of standard of living and human development
according to the United Nations’ Human Development Index (HDI).24 A majority of the countries
are in Europe: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland,
Italy, Luxembourg, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United
Kingdom. The remaining countries are located in other parts of the world: Australia, Canada, Japan,
and New Zealand.
To assess each countries’ current paid-sick-day and paid-sick-leave policies, we reviewed a range of
primary and, where necessary, secondary sources. Our primary source is original labor codes and
other labor-related legislation. The vast majority of the legislation reviewed was accessed through
NATLEX, a global database of labor, social security, and human rights legislation maintained by the
International Labor Organization (ILO). We also reviewed legislation, labor codes, and official
summaries of the main features of leave laws located on national government websites and through
web searches as well as summaries posted by well-respected international organizations, including
the ILO, the Organization for Economic Cooperation and Development (OECD), the European
20
21
22
23
24

Earle, Ayanian, and Heymann (2006).
Lovell (2005), Levin-Epstein (2007).
CCH Incorporated (2003).
Grinyer and Singleton (2000).
Our sample consists of those countries that score at least 0.94 on the Human Development Index (HDI), “a
summary composite index that measures a country’s average achievements in three basic aspects of human
development: health, knowledge, and a decent standard of living. Health is measured by life expectancy at birth;
knowledge is measured by a combination of the adult literacy rate and the combined primary, secondary, and tertiary
gross
enrollment
ratio;
and
standard
of
living
by
GDP
per
capita
(PPP
US$)”
(http://hdr.undp.org/en/statistics/faq/question,68,en.html). The Human Development Index (HDI) is calculated
yearly by the United Nations for 177 countries and areas with sufficient data and reported in their annual Human
Development Reports. See United Nations Development Programme, Human Development Report, "Human
Development Indices - A statistical update 2008", Table 1).

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Union (EU), and the United States Social Security Administration (which produces the Social Security
Systems Throughout the World country reports), as well as a small number of academic studies. To the
best of our knowledge, the policies described here are the ones in effect in each country at the
beginning of 2009. Further information on sources and details is available in Rho, Schmitt, Earle,
and Heymann (2009).
National Legislation
The 22 countries we examine here use a variety of policies to support workers with illnesses while
they are unable to work. Some require employers to cover workers’ pay while they are out sick
(Australia, Netherlands, New Zealand, Switzerland, and the United Kingdom); others operate socialinsurance systems where the government covers sick pay out of tax revenues (Canada, France,
Ireland, Italy, and Japan); most use a hybrid of employer mandates and social insurance (Austria,
Belgium, Denmark, Finland, Germany, Greece, Iceland, Luxembourg, Norway, Spain, and
Sweden).25 Some national systems include an initial waiting period, ranging from one to fourteen
days, before mandatory employer or government-insured paid sick days or paid sick leave take
effect.26 The share of usual earnings that are replaced by paid sick days and leave also varies
substantially, from full pay (Luxembourg and Norway, for example) to only a small fraction
(Australia, New Zealand, and the United Kingdom, for example). Table 1 outlines the main features
of national systems and Table 2 summarizes the financial supports provided to workers during their
absence from work.

25 See Table 1 for a summary of the structure of paid-sick-days systems in the 22 countries. Details on the systems in
each country are available in Rho, Schmitt, Heymann, and Earle (2009).
26 Employers can and often do offer paid sick days from the first day of illness, either as company policy or through
collective-bargaining agreements. Below, we examine non-mandatory employer-provided paid sick days and leave in
the United States. In the rest of the 21 countries, we only consider legally mandated or government-funded
programs.

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TABLE 1
Main Features of National Paid-Sick-Day and Paid-Sick-Leave Systems in 22 High HDI Countries
Source of Payment
Minimum Job Tenure Requirement
Country
Benefit Variations*
5-Day Flu 50-Day Cancer
5-Day Flu
50-Day Cancer
E
E
None
None
None
Australia
Payment amount depends on job
E
E & SI
None
None
Austria
tenure after 5 years of service.
120 hours in 6
E
E & SI
None
months immediately
None
Belgium
(white-collar)
prior to illness (SI)
600 hours work in
None
SI
N/A
the last 52 weeks or
None
Canada
since last claim
E (private72 hours during 8
120 hours in 13
sector); SI if not
weeks of service weeks immediately
E & SI
None
Denmark
E
(private-sector)
prior to illness
50% if less than 1 month (E);
Amount of SI benefits vary by
E
E & SI
1 month
Finland
income.
If employed for less than 12 months
800 hours in preceding 12 months (200
SI
SI
(200 hours in the preceding three
France
hours of which in first three months)
months), benefits paid for six months
E
E & SI
4 weeks of service
None
Germany
If less than one year, 100% pay for 2
weeks only. Duration of benefits
E-SI (50-50)
E & SI
1 year of service
Greece
thereafter depends on insurance
contributions.**
1 month (E); 2
Duration of payment depends on job
E
E & SI
1 month
Iceland
months (SI)
tenure.
Duration of payment depends on
SI
SI
104 weeks of insurance contributions
insurance contributions; amount of
Ireland
payment depends on income.
SI
SI
None
None
None
Italy
None
SI
N/A
2 months of service
None
Japan
E (SI refunds E (SI refunds
None
None
None
Luxembourg
80%)
80%)
E
E
None
None
None
Netherlands
E
E
6 months of service
None
New Zealand
E
E & SI
4 weeks of service
None
Norway
Spain

E (SI refunds)

SI

None

None

Sweden

E

SI

1 month of service or 14 consecutive
days of work before illness

Switzerland

E

E

3 months of service

United Kingdom

E

E

None

None

None
None
Payment amount depends on job
tenure.
SI benefit amounts depend on the
phases of sickness assessment and
the age.
None

None
None
N/A
N/A
United States
Note: E refers to employer-sponsored paid sick days; SI refers to social insurance.
*See Rho, Schmitt, Earle, and Heymann (2009) for more details on benefit variations for each country.
**Insurance contribution and tenure requirements are two separate cases. A worker with one month of employment with the same
employer, for example, may have more than one month of insurance contributions due to prior employment.
Source: See Rho, Schmitt, Earle, and Heymann (2009) for specific sources of data for each country.

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TABLE 2
Financial Supports in National Paid-Sick-Day and Paid-Sick-Leave Systems in 22 High HDI Countries
Country

Sickness Pay

Australia

10 days (100%, E)
6 weeks (100%, E), additional 4 weeks (50%, E) (25%, SI); SI
benefits continue for 52 weeks (50%, 60% after 6 weeks)

Austria
Belgium
Canada
Denmark

Finland
France
Germany
Greece

1 month for white-collar workers (100%, E), 7 days for manual
workers (100%, E) up to 2 weeks (60% plus supplemental, E); if still
ill, up to 1 year (60%, SI)
12 weeks of job protection (unpaid); 15 weeks (55%, SI)
2 weeks for private-sector (100%, E, reimbursed by SI for 2 more
weeks); if still ill, 52 weeks in an 18-month period (61.7%, SI)

12 days per year (100%, E); from 15th day (if illness lasted >20
days), up to 52 weeks in a 2-year period (ISK 1,000 plus twice the
270 for 2 dependents, 13.5%, SI)

Ireland

Up to 52 weeks (36.6%, SI)

Italy
Japan

First 20 days (50%, SI); from 21st day, up to 180 days (66.7%, SI)
Up to 18 months (60%, SI, serious illness only)
First 77 days (100%, E(80% reimbursed by SI)) until the end of the
month during which the 77th day occurs.
2 years (70%, E), min. wage not guaranteed in the 2nd year.
5 days in a 12-month period (100%, E)
16 calendar days (100%, E); if still ill, up to 52 weeks (100%, SI)
First 16 days (60%, SI refunds E); from 16th to 20th day (60%, SI);
21st day up to 12 months (75%, SI), extension up to 18 months

Netherlands
New Zealand
Norway
Spain
Sweden
Switzerland
United Kingdom

None

0

€3,930 per month

0 (E); 3 (SI)

€112.87 per day

0 (E); 1 (SI)

CAD $42,300 per year
DKK 3,515 per a 37-hr
work week
70% x 1/300 earnings for
low earners; €66.27 plus
First 9 days (100%, E); if still ill, 300 days in a 2-year period,
excluding Sundays (92.7%, SI)
40% x 1/300 earnings at
median.
12 months in a 3-year period (50%, SI)
€47.65 per day
6 weeks (100%, E); if still ill, 78 weeks in a 3-year period (70%, SI) Up to 90% of net salary
2 weeks (100%, E&SI) (50%, E during waiting period); if still ill, €15.68 per day for first 15
from 180 to 720 days (50.5%, SI)
days, €28.81 thereafter

Iceland

Luxembourg

Social Insurance Benefit Waiting Period
Ceiling
(calendar days)

First 14 days (80%, E); if still ill, up to 364 days over a 15-month
period (80%, SI); extension possible up to 550 days (75%, SI); for
more serious illness, no formal max (70%, SI).
3 weeks (100%, E)
Up to 28 weeks (£75.40, 20.3%, E), if still ill, 13 weeks of
assessment phase and additional periods of main phase (SI).

Flat rate of ISK 1,000 per
day

14 (SI)
0

0
3 (SI)
0
0 (E); 3 (SI)
0 (E); 14 (SI)

Flat rate of €204.30 per
week.
None
None

3 (SI)
3 (SI)

None

0

None
None
None
75% of earnings up to
€3,074.10 per month

0
0
0

3 (SI)

3 (SI)

SEK 321,000 per year

1 (E), 0 (SI)

None
Flat rate of £75.40 per
week for 28 weeks

0
3 (E), 3 (SI)

None
N/A
N/A
United States
Note: For full-time worker with six months or more job tenure and national median earnings (and, where relevant, with two
dependents). Per-year basis if not noted otherwise. For Denmark, Finland, Greece, Iceland, we use the 2005 average worker earnings;
for Ireland, average production worker earnings (as specified in OECD, 2007, p.185); for United Kingdom, 2008 weekly median
wage (retrieved from UK office for National Statistics) to calculate full-time equivalent wage replacement rate. In Australia, Finland,
France, Greece, Ireland, Switzerland, and United Kingdom, amounts of benefits vary by job tenure, insurance contributions, income,
or age. See Table 1.
Source: See Rho, Schmitt, Earle, and Heymann (2009) for specific sources of data for each country.

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In order to facilitate comparisons across these often very different policies, we have asked how
national policy would treat an identical worker facing two different illnesses in each country. The
worker we follow: receives the national median earnings27 (since benefit rates sometimes depend on
a worker’s level of earnings); has been with the same employer for six months (eligibility sometimes
depends on past employment history, including in some cases time with current employer); works
full-time (in some cases benefits vary by number of hours worked); is in a workplace with 25 or
more employees (in the three U.S. cities with paid-sick-day laws, entitlements vary by establishment
size); and has two dependents (in a few cases benefit levels increase with the number of
dependents).
We analyze the impact of national policies on this typical worker in two different circumstances. In
the first case, we calculate the total full-time equivalent28 pay the worker would receive if he or she is
out of work for five days with the flu. In the second case, we tally the full-time equivalent pay the
same worker would receive if he or she is out of work for fifty days while undergoing cancer
treatment.
Five-Day Flu

Figure 1 presents the results for both policy experiments. Starting with the case of a five-day flu, the
figure shows the portion of a worker’s earnings over the five-day absence that are replaced by the
national paid-sick-day system in each country. If a country requires employers to compensate sick
workers with a full day’s pay for all five days, the full-time equivalent days displayed in the figure
would be five. If a country excludes payment for the first day, but pays subsequent days out of a
social-insurance fund at full pay, then the full-time equivalent payment in the figure would be four
days. If a country guarantees 70 percent pay for all paid sick days, then the figure would show 3.5
days (5 days times the 70 percent replacement rate).
U.S. law provides no financial support for a worker with a five-day flu. Canada and Japan are the
only other countries of the 22 analyzed here that also have no mandated support for workers.
Japanese law provides paid sick days for “serious” illnesses (lasting up to 18 months), but Figure 1
assumes that the five-day flu would not rise to the serious illness standard.29 In Canada, decisions
regarding job protection are made at a provincial level due to the federal division of powers, though
long-term illness insurance is provided federally and described below.30
Eleven countries – Australia, Austria, Belgium, Denmark, Finland, Germany, Iceland, Luxembourg,
New Zealand, Norway, and Switzerland – give the typical worker full pay while recovering from a
five-day illness. In Greece and the Netherlands, workers receive the equivalent of 3.5 days pay when
they are out sick for five consecutive days.31 In Sweden, paid sick days cover 3.2 days of pay during a
five-day illness.
Workers are guaranteed a smaller share of pay in the rest of the countries: Spain (1.2 days out of
five), France (1), Ireland (0.7), and the United Kingdom (0.4). Payments are less generous in these
27 See Appendix for further details.
28 See Appendix for more information on calculating full-time equivalent paid sick days.
29 And in any event, the serious illness protection under the Employees Health Insurance Program (Shakai Hoken) has
an initial three-day waiting period before payment begins.
30 Chaussard, Gerecke, and Heymann (2008).
31 In the Netherlands, workers receive 70 percent of pay from the first day of illness. In Greece, workers receive 50
percent of pay for the first three days and full pay for the last two. In Sweden, workers are entitled to receive 80
percent of pay, but there is no legal guarantee of payment for the first sick day. For full details for these three and all
other cases, see. Rho, Schmitt, Earle, and Heymann (2009).

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countries primarily because they provide no legal guarantees of pay during the first three days of
illness-related absences.
As Figure 2 shows, for low-wage workers earning half the median national earnings, the full-timeequivalent benefits are more generous in Ireland (rising from 0.7 to 1.5 paid FTE days) and the
United Kingdom (increasing from 0.4 to 0.8 FTE days).
Figures 1 and 2 exclude voluntary employer policies or collectively bargained agreements covering
paid sick days. Below, we present evidence from survey data on the extent of employer-provided
and collectively bargained paid sick days in the United States.
Fifty-Day Cancer Treatment

Figure 1 also summarizes the full-time-equivalent benefits paid to a worker who is absent from work
for 50 working days, as might occur in the case of treatment for an illness such as cancer. In this
case, the United States is the only country that has no guaranteed paid sick leave. Luxembourg and
Norway provide full pay for the 50 missed days. Three more countries also mandate more than 40
days: Finland (47), Austria (45), and Germany (44); ten countries guarantee between 20 and 40 days
of full-time equivalent earnings: Belgium (39), Sweden (38), Denmark (36), Netherlands (35), Spain
(33), Italy (29), Greece (29), Japan (28), France (24), and Canada (22). The rest mandate at least five
days: Iceland (17), Ireland (17), Switzerland (15), Australia (10), the United Kingdom (10), and New
Zealand (5). In most of the countries, government social-insurance programs rather than employer
mandates cover most of the costs of paid sick leave in the case of a fifty-day absence.32
In six countries, paid sick leave available to low-wage workers is even more generous than it is for
the typical worker (see Figure 2). A low-wage worker earning only half of the national median and
facing a fifty-day absence from work receives 50 FTE paid days in pay in Greece and Denmark,
compared to 28 for the median worker in Greece and 36 for the median worker in Denmark. In
Ireland, a low-wage worker is entitled to 34 paid days, compared to 17 for a worker at median
earnings; in Iceland, a low-wage worker receives 25 paid days, compared to 18 for the median
worker; in the United Kingdom, there are 19 days for the low-wage worker, compared to 10 for the
worker at the median. In Finland, the advantage for low-wage workers is smaller because the
benefits are high for all (50 weeks compared to 48 at the median).

32 Sources and details on the systems in each country are available in Rho, Schmitt, Earle, and Heymann (2009).

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




10

FIGURE 1
Paid Sick Days and Leave in 22 Countries, Worker at Median Earnings
(Full-time equivalent working days)

50

Luxembourg

5

Norway

5

Finland

5

Austria

5

Germany

5

Belgium

5

50
48
45
44
39
38

Sweden

3.2
36

Denmark

5
35

Netherlands

3.5
33

Spain

1.2

Italy

1

29
28

Greece

3.5
28

Japan

0

France

24
1
22

Canada

0
18

Iceland

5
17

Ireland

0.7
15

Switzerland

5

Australia

5

10
10

United Kingdom

0.4
5
5

New Zealand

50-Day Cancer
5-Day Flu

0

United States
0

5

10

15

20

25

30

35

40

45

50

Working Days

Notes: For full-time worker with six months or more job tenure, earning the national median, and, where relevant,
with two dependents.
Sources: See Appendix for more information on calculating full-time equivalent paid sick days. See Rho, Schmitt,
Earle, and Heymann (2009) for specific sources of data for each country.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




11

FIGURE 2
Paid Sick Days and Leave in 22 Countries, Worker at Half the Median Earnings
(Full-time equivalent working days)

50

Luxembourg

5

Norway

5

Finland

5

Austria

5

50
50
45
44
Germany

5
39

Belgium

5
38

Sweden

3.2
50

Denmark

5
35

Netherlands

3.5
33

Spain

1.2

Italy

1

29
48
Greece

3.5
28

Japan

0
24

France

1
22

Canada

0
25

Iceland

5
34

Ireland

1.5
15

Switzerland

5

Australia

5

10
19

United Kingdom

5
5
5

New Zealand

50-Day Cancer
5-Day Flu

0

United States
0

5

10

15

20

25

30

35

40

45

50

Working Days

Notes: For full-time worker with six months or more job tenure, earning half the national median, and, where
relevant, with two dependents.
Sources: See Appendix for more information on calculating full-time equivalent paid sick days. See Rho, Schmitt,
Earle, and Heymann (2009) for specific sources of data for each country.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




12

Beyond Federal Mandates: State and Local Policy and
Voluntary Steps by Firms in the United States
The United States is the only country of the 22 studied here that has no legal provisions for paid sick
days or leave of some form. In this section, we review the impact of employer policies and state and
local legislation on the availability of paid sick days and leave in the United States.33 The existing
patchwork of employer policies and state and local legislation leaves a large portion of the workforce
without paid sick days and leave. Low-wage and part-time workers, who are disproportionately
women, appear to be particularly likely to be without paid sick days and leave.
Employers
According to the most recent available data from the Bureau of Labor Statistics’ National
Compensation Survey (NCS) (covering March 2008), 39 percent of private-sector workers in the
United States have no paid sick days or leave.34 The availability of paid sick days and leave varies
widely by worker characteristics. Only 27 percent of part-time private-sector workers have paid sick
days or leave, compared to 71 percent of full-timers. Low-wage workers are also much less likely to
have paid sick days or leave than higher wage workers. Only one-in-four (23 percent) private-sector
workers in the bottom 10 percent of the wage distribution in their occupation, for example, have
paid sick days or leave, compared to more than 8-in-10 (83 percent) workers in the top 10 percent of
their occupational wage distribution. Private-sector workers at small establishments are also less
likely than workers at larger establishments to have paid sick days or leave. At establishments with
between one and 49 employees, for example, only about 51 percent of workers have paid sick days
or leave, compared to 78 percent at establishments with 500 or more workers. Non-union workers
are also less likely to have paid sick days or leave (60 percent) than workers who are in unions (66
percent).35
These BLS estimates drawn from the NCS, however, almost certainly overstate paid-sick-day
coverage in the United States.36 As Lovell (2007) has noted, “[t]he NCS data are on whether jobs are
covered by a paid sick days policy; incumbents in those jobs may not yet have met employerimposed eligibility thresholds related to job tenure.”37 After Lovell adjusts for the share of workers
in each occupation that have been on the job for less than the average minimum requirement for
paid-sick-day eligibility, she finds a lower rate of paid-sick-day coverage than the BLS reports.38
Using 2006 data, Lovell’s adjustment appears to reduce coverage by about four percentage points. If
we add four percentage points to the 39 percent non-coverage rate from the raw NCS data, the
share of private-sector workers without paid sick days rises to 43 percent.39

33 For more information, see Rho, Schmitt, Earle, and Heymann (2009).
34 Kramer and Zilberman (2008), Table 2. The BLS term refers to what we call paid sick days and paid sick leave here.
35 For other recent analyses of paid-sick-day coverage, see also: Clemans-Cope (2008), Hartmann (2007), Lovell (2004),
National Partnership (2004), and Phillips (2004).
36 The NCS data cover both paid sick days and paid sick leave; we follow Lovell's treatment here, which treat the NCS
data as referring to “paid sick days.”
37 Lovell (2007), p.4. Emphasis in original.
38 Beginning in 2008, the BLS also changed its methodology for determining paid-sick-day coverage, which had the
effect of raising paid-sick-day coverage by one to two percentage points relative to the old methodology.
39 For the total private-sector workforce, see the Economic Report of the President (2009), Table B-46. The 49 million
figure does not include any workers without paid sick days among: public employees at the federal, state, and local

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




13

Unfortunately, available data do not allow us to measure the generosity of employer-provided paidsick-day and paid-sick-leave policies. The NCS data, for example, do not provide information on
either the number of paid sick days available to workers or the rates at which those sick days are
compensated. Comprehensive data were similarly unavailable on the voluntary provision by
companies beyond the minimum legislated requirements in the 21 other countries. Even with these
limitations, available data on coverage make clear that the voluntary system in the United States has
left far more working men and women with no paid sick days or leave than the employer mandates
and social insurance programs in comparable countries.
State and Local Laws
Five U.S. states – California, Hawaii, New Jersey, New York, and Rhode Island – have legislation
that provides eligible workers with temporary disability benefits that can provide paid sick leave for
temporary illnesses that last longer than seven work days.40 Three U.S. cities – Milwaukee, San
Francisco, and Washington, D.C. – have also passed legislation requiring that most employers
provide a limited number of paid sick days to most employees. Table 3 summarizes the basic
features of the five state and three city laws. Figure 3 shows the generosity of the state and city
plans for workers facing the same five-day flu or a fifty-day cancer treatment in Figures 1 and 2.
Since all five states exclude illnesses of less than eight days from coverage, all the state plans provide
zero full-time equivalent days of pay for a five-day illness. However, three of the five states provide
about six weeks of full-time equivalent pay for a worker that misses 50 days of work due to illness:
New Jersey (31), California (29), and Hawaii (28). New York provides almost 11 days of full-time
equivalent pay for a fifty-day absence. Rhode Island’s system grants 30 weeks of coverage, but at
much lower benefit rates. As a result, the state’s system covers only about three days of full-timeequivalent earnings over a fifty-work-day illness.
The three city laws focus on shorter-term illnesses, with full costs of between three and ten paid sick
days per year borne by employers. For a five-day flu, our representative worker, with six months of
job experience in a firm of 25 employees, would receive full pay in Milwaukee and San Francisco as
well as in Washington, D.C., although in the District of Columbia the law has important exemptions
and conditions.41 Since Washington, D.C., requires that a worker have one year of tenure with the
same employer, our representative worker with only six months tenure is not eligible for paid sick
days under the Washington, D.C., legislation. For a fifty-day cancer treatment, Milwaukee and San
Francisco guarantee nine days of full-time-equivalent paid sick days (the maximum number of days
required under both city laws); and, Washington, D.C., provides five days of full-time equivalent
paid sick days.

levels; agricultural workers; household employees; and the self-employed. Inclusion of these groups obviously raises
the number of uncovered workers significantly.
40 Eligible workers will begin to use New Jersey's paid-sick-day provisions beginning July 1, 2009.
41 As Table 3 states, employees must have worked one full-year and at least 1,000 hours during the 12-month period
prior to illness before being eligible for paid sick days. In addition, the Washington, D.C., law explicitly excludes
“health care workers who choose to participate in a premium program” and “restaurant wait staff and bartenders
who work for a combination of wages and tips” (Council of the District of Columbia, 2008). The accrual rate and the
annual maximum paid sick days also vary by firm size, with small employers required to provide fewer paid sick days
than larger employers. Businesses with under 25 employees are required to provide three paid sick days, those with
25 to 99, five days, and those with 100 or more employees, seven days.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




14

TABLE 3
Summary of State and Local Paid-Sick-Day and Paid-Sick-Leave Provisions in the United States
Source of Funding

Weekly Benefit Amount

Payment Waiting
Duration Period

California
Hawaii

26 weeks

7

New Jersey

20 weeks of NJ employment
with $143 earnings; or
$7,200 earnings during base
year period

Up to $546; 2/3 of average
weekly earnings (based on 26 weeks
last eight weeks)

7

New York

Employers, by purchasing
insurance or self-insuring;
Up to $170; 50% of
4 consecutive weeks of work they may pay the entire cost average weekly earnings 26 weeks
or employees may contribute (based on last eight weeks)
<=60 cents per week

7

$69-$671; 4.62% of high
quarter wages up to 85% of
state's average weekly
Financed entirely by
wage in preceding calendar 30 weeks
employee payroll deductions
year, plus the greater of
$10 or 7% of benefit rate
for each dependent up to 5

7

Washington,
D.C.

San
Francisco

14 weeks of HI employment,
including 20 hours of pay;
and $400 earnings in the 52
weeks preceding the first day
of disability

Rhode Island

$50-$959; 55% of average
weekly earnings in the
Employee payroll deductions
52 weeks
highest quarter of the base
period

$300 earnings during base
period

Milwaukee

Cities with Paid Sick Days ordinance
(For 5-Day Flu)

States providing Temporary Disability Insurance Programs
(For 50-Day Cancer)

Qualifying Conditions

$8,800 earnings in base or
alternate base period

Employers, by purchasing
insurance or self-insuring

Both employees and
employers contribute

$1-$510; 58% of average
weekly earnings

Rules for Payment Duration
(by business size)
Accrual starts 90 days after
1 hr of leave per every 30 hr worked.
the day of hire; if hired prior
If >=10 employees, up to 72 hrs of
Employers (provide full pay)
to Feb. 5, 2007, accrual
leave (9 days); if <10 employees, up to
started on Feb. 5, 2007.
40 hrs of leave (5 days)
If >=100 employees, 1 hr of leave for
Accrual starts on the day of
every 37 hrs worked (max 7 days); if
hire (after Nov. 13, 2008);
25>= employees >100, 1 hr of leave
access date starts after one Employers (provide full pay)
for 43 hrs (max 5 days); if <25
year and 1,000 hours of
employees, 1 hr of leave for 87 hrs
work.
(max 3 days)
1 hr of leave per every 30 hr worked.
Accrual will start on the day
If >=10 employees, up to 72 hrs of
of hire, and on the day of Employers (provide full pay)
leave (9 days); if <10 employees, up to
ordinance implementation.
40 hrs of leave (5 days)

7

0

0

0

Notes: Ordinance in Washington D.C. excludes a) health care workers participating in a premium pay program instead, and
b) restaurant wait staff and bartenders who work for a combination of wages and tips. Ordinance in Milwaukee is currently
on a temporary injunction.
Sources: See Rho, Schmitt, Earle, and Heymann (2009) for specific sources of data for each state and city.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




15

FIGURE 3
Paid Sick Days and Leave in the United States
(Full-time equivalent working days)

31.3
New Jersey

0

C alifornia

0

Hawaii

0

New York

0

29
28.4
10.6
2.6

Rhode Island

0

9
San Francisco, C A

5
9

Milwaukee, WI

5

50-Day C ancer
5-Day Flu

0

Washington, DC
0

5

10

15

20

25

30

35

40

45

50

Working Days

Notes: For a worker with six months or more job tenure, earning the national median, in an establishment with 25
employees. In Washington D.C., employees can access the leave after one year of continuous service and 1,000
hours of work in a 12-month period immediately preceding the illness.
Sources: See Appendix for more information on calculating full-time equivalent paid sick days. See also Rho,
Schmitt, Earle, and Heymann (2009) for specific sources of data for each state and city.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




16

Conclusion
Everyone is vulnerable to illness and injury. Unlike the rest of the world’s rich economies, the
United States relies on voluntary employer policies to provide paid sick days to employees with
short-term illnesses. As a result, at least 40 percent of the private-sector workforce in the United
States does not have paid sick days or leave.
The rest of the world’s rich economies have taken a legislative approach to ensuring paid sick days
or paid sick leave. Of the 22 rich countries whose labor law we analyze here, all but the United
States guarantees some form of paid time off tied specifically to illness. The United States is the only
rich country in the world that does not mandate any form of paid sick days or leave. As a result,
each year millions of American workers go to work sick, lowering their own productivity and that of
their coworkers and potentially spreading illness to their coworkers and customers. Other sick
workers lose pay and risk job loss when they miss work to address personal and family health needs.
Always critical, addressing this policy gap is more urgent in the current economic downturn.

Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries




17

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20

Appendix: Full-time Equivalent Paid Sick Days
This reports uses full-time equivalent (FTE) paid sick days (or paid sick leave) to simplify the
comparison of paid sick days and paid sick leave policies across our 22 high HDI countries. FTE
paid sick days are calculated as the wage replacement rate multiplied by the duration of paid time off.
A number of countries provide paid sick days and paid sick leave at the same rate to all their workers
(Iceland, Ireland, and the United Kingdom).
Some countries seek to save money by placing a cap on the amount paid for sick days and leave
(Denmark and Greece). In these countries, lower paid workers receive a higher percentage of their
earnings or higher FTE equivalent than higher paid workers. To provide the reader with an estimate
of how many days the typical worker with median earnings and the low-wage worker with half
median earnings would receive, we conduct estimates.
When calculating these FTE paid sick days, we make a few simplifying and standardizing decisions.
In the absence of internationally comparable, recent data on median national earnings, we use
internationally comparable data from the OECD on mean wages for 2005 (OECD, 2007), which we
adjust in two ways. We increase the mean wage by 2005-2008 wage growth in each country (using
OECD, 2008, Annex Table 11). We then multiply these estimated 2008 mean wage rates by 0.85 to
create estimated 2008 median national earnings levels in national currencies.
If benefits through a social-insurance program have a waiting period and take effect after an initial
employer-mandated leave, we assume that the waiting period for social-insurance benefits occurs
during the initial employer-mandated period.
Finally, in order to facilitate the discussion of duration of leave, every leave in each country is
standardized to a single time unit of ‘working days’, assuming that there are five working days per
week for every country (we make necessary adjustments for countries that specify a different
number of working days per week). In countries whose social-insurance fund provides daily sickness
benefits on a calendar-day basis, we convert the sickness benefits to a working-day basis. For
example, if a worker is paid a daily sickness benefit of $100 for a calendar week, the worker would
receive a total of $700 in sickness benefits per week. When calculating full-time equivalent paid sick
days, however, we calculate that the worker receives $140 ($700 divided by 5 working days) of
sickness benefits per working day for five days.