Fries with a side of the stomach bug: How “points systems” put workers and the public at risk

A fast-food worker has a stomach bug, but she shows up to her shift and does her best to wash her hands carefully. A retail worker’s toddler has COVID, but she’ll be penalized if she stays home to take care of him, so she leaves him with a neighbor. A grocery store clerk has had increasing shortness of breath for weeks—and while, legally, he has sick leave, he feels he can’t risk missing work for a doctor’s appointment. 

This practice of showing up to work despite being sick—called presenteeism—puts workers, their families, and the broader public at risk. And according to new research from HKS Professor Daniel Schneider and co-authors, it’s exacerbated by “points systems” that assign workers penalties, or “points,” for being late or missing work, even if it’s for illness. In some cases, workers can lose their jobs for accruing too many points. 

In their article in Health Affairs, Schneider and his co-authors explored the impact of these points system on people working for large retail, big box, grocery, pharmacy, delivery and fulfillment, fast food, and casual dining firms. They examined if the impact differed when workers were protected by paid sick leave mandates. 

How do points systems impact people showing up to work sick? 

Points-based attendance systems were associated with an increase in presenteeism by nearly 19 percentage points as service sector workers were much more likely to show up to work sick when they could receive penalizing “points” for staying home. 

This was especially true for workers who had already received “points” and experienced consequences for it. The likelihood of these workers coming in while sick was around 39% higher than for workers whose job had no points system. But, even those workers who had not yet been sanctioned, but who worked at an establishment with such a system, were more likely to work sick.

What are paid sick leave protections? 

Paid sick leave offers workers the ability to accrue protected time off, or sick leave, that they can use when they’re sick, need to go to doctor’s appointment, or are caring for sick family members. Research has found these policies reduce both presenteeism and the spread of disease.   

There’s no national guarantee for paid sick leave, but by 2024, 15 states and four cities and counties had their own mandates. It’s uncommon for service-sector employers to voluntarily offer workers paid sick leave, but even the presence of these laws isn’t always enough. Some employers don’t comply with these protections, and workers may not feel safe to take the time off that they need and are legally entitled to. 

In 2024, Schneider and co-authors surveyed workers in California, which has a paid sick leave requirement. They found that 29% of workers reported conditions that violated that standard. 

How do paid sick leave protections interact with points systems?

One possibility is that points systems are less common in states that have implemented paid sick leave mandates. But Schneider and his co-authors found that, in fact, the presence of a paid sick leave law doesn’t reduce the likelihood of employers using points systems. 

Further, points systems had the same negative consequences for presenteeism whether or not workers were employed in jurisdictions with paid sick leave mandates or not, suggesting that points systems serve to undermine the intent of these labor protections. 

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Photograph by Emanuele Cremaschi/Getty Images