An Irrational Decision? Preventative Care Use Declines During High Unemployment

When considering that a drop in preventative care visits is correlated with a rise in state unemployment, is it possible that the market-based properties of healthcare in the United States cause a drop in the demand for highly-beneficial preventative medical services?

Nathan Tefft of the University of Washington School of Public Health spearheaded a study seeking to answer that question in the February 1, 2014 edition of Health Services Research. He proposes that such care has lower demand during episodic high unemployment because there is an immediate cost but a delayed benefit. In other words, reduced jobs in a market and the resulting tightening of financial resources decrease the number of annual check-ups and follow-up care in the US because these are, by nature, preventative and have no obvious or immediate result. This is in contrast to urgent and emergency care, which are utilized specifically for immediate treatment of an ailment. However, deferring preventative care such as blood tests or cancer screenings can have deleterious effects on both the societal and individual level because the onset or mismanagement of chronic and acute diseases is costly.

In order to explore this effect, Tefft employed the results of a CDC telephone survey in which 5,056,289 interviews were conducted between the years of 1987 and 2010 and compared the results to the US Bureau of Labor Statistics’ state-level unemployment rates during the same time period. He reports that a one percent increase in the rate of state unemployment is accompanied by a 1.58 percent decrease in the utilization of preventative health services. Among women surveyed there is a 1.96 percent decrease in the use of preventative medical services for every one percent increase in unemployment and a near doubling of that figure for all black respondents.

To investigate this effect further, Tefft also examined preventative healthcare usage contingent on respondents who have seen a primary care physician for an annual check-up in the previous 12 months. He finds that men decrease their number of annual check-ups during times of high unemployment while women as a population tend to continue their annual check-ups but decrease follow-up preventative care.

The results of this study confirm that there is a correlation between the loss or lack of employment and a decrease in the use of preventative health services. Whether this is due to not having access to employer-based healthcare is not clear.  However, federal programs such as COBRA exist that allow one to buy health insurance through one’s former employer after termination, providing a safety net of sorts for those who become unexpectedly jobless. As such, the loss of employer-based health insurance may be less responsible than other factors for the decrease in preventative care visits.

What is more likely, as suggested by Tefft’s research, is that preventative care is looked upon as a good for which demand decreases as resources are shifted as unemployment rises. It should also be noted that demand for these services does not only fall amongst those who have lost or lack employment. The threat of rising unemployment could cause those who have jobs to buffer their rainy-day funds and to cut back on things they do not deem as immediately necessary. If both the threat and actuality of losing one’s job cause consumers to frame preventative medical services as an immediate cost with a delayed payoff, they are likely to defer such care.

As Tefft notes, policy makers need to be aware of this dynamic between increasing unemployment rates and decreasing preventative care visits. While local, state, and federal coffers accumulate less revenue when the work force shrinks, it is imperative that programs designed to encourage access to preventative healthcare services not be legislatively curtailed during budget negotiations. Doing so could cause a future increase in costly chronic diseases such as diabetes, ailments preventable through prophylaxis, and cancer that may go undetected in early stages. Frankly, that scenario is far more threatening to the public and policy makers of tomorrow, though slashing the low-hanging fruit of free cancer screenings and flu shots may seem more financially amenable today.

Feature Photo: cc/(Julep67)