Nearly half of the hourly workers in a new Health Affairs study said their employer runs a points system. Late, leave early or miss a shift, for any reason including illness, and a point goes on the record. Collect enough and you can be fired.
The June 2026 paper, titled “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. It finds a strong link between those systems and presenteeism, meaning going to work while sick. Such policies are common at big retail, grocery, pharmacy, fast food and fulfillment employers.
The numbers
Using data from the Shift Project, the researchers found that being exposed to a points system went with an 18.9-percentage-point rise in presenteeism. The increase grew with how deeply a worker was caught up in the system.
Workers under a points system who had not yet picked up any points were 9.3 percentage points more likely to work sick than workers with no such system. Those who had accrued points were 29.5 percentage points more likely. Those who had accrued points and also faced consequences were 38.7 percentage points more likely.
The threat alone changed behavior. Exposure was tied to an 18.1-percentage-point increase in the likelihood that workers said they came in sick specifically to avoid losing or earning a point.
Sick leave laws did not help
State and local paid sick leave laws are spreading, but they made little difference here. Roughly half the workers in the study reported a points system whether or not their employer operated where a paid sick leave mandate applied. Those mandates did not make employers less likely to use points, and they did not weaken the link between points and presenteeism. Workers covered by such laws showed up sick under a points system just as often as workers without them.
The authors read this as the points systems effectively cancelling out the public health benefit the laws are meant to deliver.
The risk is sharpest in the service sector, where staff often deal with customers directly or handle, prepare or serve food. In those jobs a sick worker can pass on a communicable disease.
“While employers have a justifiable business need to ensure staffing, our work shows that points systems go far beyond those purposes, punitively sanctioning working people in ways that undermine their health and the public health,” said Daniel Schneider, the Malcolm Wiener Professor of Social Policy at the Harvard Kennedy School and co-director of the Shift Project.
The study is by M. Slopen and colleagues.
Consult your doctor for medical advice.
