An insurance program exists in California that allows parents of children with special health needs to take paid family leave. However, according to a paper published in the September 3 issue of JAMA, few people are aware of the program and only 5% of those surveyed have used the program.
Some 13 to 17 percent of children in the United States are considered chronically ill or have special health care needs. Children with illnesses such as cerebral palsy, chronic kidney failure, congenital heart diseases, cystic fibrosis, degenerative neurological disorders and malignancies fall into this category. “Children with special health care needs average 3 times as many medical encounters as other children, account for one-half of child hospital days, and miss nearly 3 times as much school. Their health-related needs create substantial pressure on parents to miss work,” write Mark A. Schuster, M.D., Ph.D. (Children’s Hospital Boston and Harvard Medical School) and colleagues, authors of the study.
As the first state to provide paid leave to care for an ill family member, California authorized the Paid Family Leave Insurance Program (PFLI) in 2004. The program consists of 6 weeks of non-job-protected paid leave every year for most part-time and full-time employees, at approximately 55% of salary. The program is paid for through deductions that occur automatically in the payroll system, as it is a government-mandated insurance program. Although California’s program has been used to model state and federal paid family leave efforts, researchers have yet to determine its impact.
In order to evaluate some aspects of the PFLI, Schuster and colleagues examined parents’ reports of taking leave before the start of PFLI and after its implementation. A sample of 754 parents were surveyed in the “before” group from November 21, 2003 to January 31, 2004, and 766 parents were surveyed in the “after” group from November 18, 2005 to January 31, 2006. Data were collected primarily through telephone interviews with employed parents of children with special care needs who were randomly sampled from a children’s hospital in California (a state with PFLI) and a children’s hospital in Illinois (a state without PFLI).
One important finding was that only 18% (77 parents) reported having heard of PFLI and only 5% (20 parents) reported using it. In California, the PFLI was not linked to an increase in parents taking leave from before to after the program began. Specifically, in California before PFLI, 81% of parents surveyed took at least one day off to care for a sick child compared to 79% of parents after PFLI began. Corresponding percentages in Illinois were 78% and 79%.
Further, the PFLI was not associated with an increase in the amount of time that parents took off to care for ill children. At least four weeks were used by 21% of California parents and 14% of Illinois parents before PFLI began compared to 19% of California parents and 11% of Illinois parents after PFLI began. Further, 41% of California parents and 36% of Illinois parents reported before PFLI began that at least once in the past year they did not miss work even though they thought their child’s illness called for it. The percentages remained similar after PFLI was initiated.
Schuster and colleagues write that, “Many factors may explain the minimal use of PFLI, but lack of awareness is likely important. Uptake of new policies generally requires a combination of awareness, low perceived costs (e.g., minimal income loss), and high perceived benefits (e.g., improving children’s health, allaying children’s fears).”
“For policymakers considering paid leave programs, our findings suggest that it is insufficient for employees to learn about the program only when starting a new job or requesting leave. Additional dissemination (e.g., media campaigns, periodic employer-based notification of all employees) may raise awareness,” the authors conclude. “Maximizing uptake of paid leave programs among parents of children with special health care needs may be a particularly important policy goal, given their substantial need for leave.”
In an accompanying editorial, John M. Neff, M.D. (Children’s Hospital and Regional Medical Center, Seattle) writes: “To correct the deficiencies in the use of paid leave, extensive and frequent employee education about the existence of the program must occur…Ideally, future legislation should ensure that use of these funds will not affect future employment or job opportunities. Other important considerations include length of coverage, the amount of payment, and the funding source.”
He concludes: “An important issue for states to consider is that failure to enact paid family leave legislation will likely increase costs to the state and to the family. Paid family leave legislation provides incentives to keep individuals in the work force, taking advantage of the upfront education and job training that has already occurred. Without such legislation, parents of children with serious chronic health conditions are likely to drop out of the work force and lose employment-based insurance. Medicaid case loads and expenses are likely to increase with increased enrollment of chronically ill children at the high end of the health care cost spectrum.”
Awareness and Use of California’s Paid Family Leave Insurance Among Parents of Chronically Ill Children
Mark A. Schuster; Paul J. Chung; Marc N. Elliott; Craig F. Garfield; Katherine D. Vestal; David J. Klein
JAMA (2008). 300[9]: pp. 1047 – 1055.
Written by: Peter M Crosta