CAMBRIDGE, Mass., June 11 — A new study published in the June 2026 issue of Health Affairs has found that employer points systems, which penalize workers for absences regardless of the reason, are strongly associated with presenteeism, the practice of showing up to work while sick.
The research, Points-Based Attendance Systems Associated With Presenteeism Despite Paid Sick Leave Protections, draws on 2024 survey data from more than 3,000 hourly service-sector workers at 63 large U.S. firms.
Points-based attendance systems are policies under which employees accumulate points, occurrences, or demerits for being late, leaving early, or missing work for any reason, including illness, with consequences that can include termination.
These systems are widespread among large retail, grocery, pharmacy, fast food, and fulfillment employers.
Despite growing adoption of paid sick leave laws at the state and local level, nearly half of workers in the study reported being subject to a points system, regardless of whether their employer operated in a jurisdiction with a paid sick leave mandate.
The effects of these systems on workers are significant, with exposure to a points system associated with an increase in presenteeism.
The study found that workers subject to a points system were more likely to work while sick than those not exposed to any such system.
Workers who had accrued points were more likely to come in sick.
The researchers found that the effects followed a clear gradient based on the degree of exposure.
Drawing on data collected through the Shift Project, the researchers were able to examine the impact of points systems on worker behavior.
A key finding of the study is that points systems undermine the public health benefits of paid sick leave laws.
Even in jurisdictions where paid sick leave protections are on the books, workers may still feel pressured to come to work while sick due to the consequences of accumulating points.
This can have serious consequences for public health, as workers who come to work while sick can spread illness to their colleagues and customers.
The study’s findings have important implications for employers and policymakers.
By understanding the impact of points systems on worker behavior, employers can take steps to create a healthier and more supportive work environment.
Policymakers can also use this research to inform their decisions about paid sick leave laws and other policies aimed at promoting public health.
The study is a significant contribution to our understanding of the complex relationships between workplace policies, worker behavior, and public health.
As researchers continue to explore these issues, we can expect to see new insights and discoveries that will help us create a healthier and more equitable society.
Looking ahead, it will be important to watch for further research on the impact of points systems and other workplace policies on worker behavior and public health.
Consult your doctor for medical advice.
