Academic journal article Atlantic Economic Journal

Local Labor Market Condition and Influenza Vaccination

Academic journal article Atlantic Economic Journal

Local Labor Market Condition and Influenza Vaccination

Article excerpt

Introduction

Influenza vaccination is a cost-effective preventive service, and is a core component of any preventive service package. Maciosek et al (2006) found that about 275,000 quality-adjusted life years (QALYs) would be saved if influenza vaccination was offered annually to all people 50 years or older. The 2010 Patient Protection and Affordable Care Act required insurance policies beginning on or after September 23, 2010 to provide full coverage on influenza vaccination without any copayment or co-insurance. Despite its effectiveness and low costs, influenza vaccination rates remain low in the U.S. The Healthy People 2020 is a program of the U.S. Department of Health and Human Services. Its targets include achieving influenza vaccination rates of 90% among adults aged 65 years and older, and 80% among adults aged 18 to 64 years, but the actual rates were only 66.2% and 35.7% respectively during the 2012-2013 influenza season (CDC 2013). There are also large disparities of vaccination rates across regions and across racial or ethnic groups.

Many studies have explored possible predictors and causes for low vaccination rates. This area of research is critical for designing sound public health policies to promote flu vaccination in particular and preventive care in general. In addition to individual factors such as socioeconomic, demographic characteristics, and perceived risks and benefits towards vaccination (Tsutsui et al. 2010 and Maurer 2009), more and more studies are focusing on external factors such as local or national economic conditions and neighborhood socioeconomic status as important determinants of individual health behaviour. These external factors may influence individual behavior through changing the opportunity cost of care (e.g. Colman and Dave 2013 and Ruhm 2005) and affect individuals' knowledge of healthcare beliefs about the benefits of prevention, trust of the healthcare system and providers, and allocation of public health resources (Benjamins et al. 2004 and Zimmennan et al. 2009). For example, Coughlin et al. (2008) found that county-level variables such as residence in a health professional shortage area, racial or ethnic composition, and density of obstetrician-gynecologists were associated with the use of breast and cervical cancer screening among women who were 40 years and older.

Among these external factors, a growing number of studies found macroeconomic conditions measured by unemployment rates to have a strong influence on various health outcomes and health behavior including mortality, obesity, general health status, medical services and hospital spending, smoking and exercise (e.g. Ruhm 2005, Colman and Dave 2013 and McInerney and Mellor 2012). Macroeconomic conditions affect individual health behavior by changing the opportunity costs, affordability of healthcare services and psychological conditions.

Despite progress in this research area, studies on the relationship between local economic conditions and flu vaccination are limited. Most relevant are the following three studies. Tefft and Kageleiry (2014) examined the impacts of state-level unemployment rates and state-level per capita income on two aggregate measures of preventive services: a dichotomous variable on whether a person used any preventive service and the total number of services used by a respondent. The authors found that deterioration in local labor markets was associated with decreased usage of preventive care in both measures. The second study by Markowitz et al. (2010) used a dynamic panel data model to analyze the monthly flu rate at the national and state level from 1997 to 2008. The authors found a positive association between employment rates and the spread of flu. However, somewhat opposite results were reported in Cornwell (2012) who examined inter-state variations in flu activities from 1999 to 2010. The author found that states with higher unemployment rates ran a higher risk of widespread influenza. …

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