Fluctuations in the unemployment rate affect people's health care choices, finds a new study in Health Services Research. Specifically, a one percent increase in state unemployment corresponded to a 1.58 percent reduction in the use of preventive health care services such as mammograms, pap tests, and annual check-ups.
"A one percentage point change in the unemployment rate is a substantial shift in employment conditions, and the associated change in preventive services is similarly important," said Nathan Tefft, Ph.D., assistant professor in the School of Public Health at the University of Washington, Seattle, and lead author on the study.
The findings are based on an analysis of data from surveys conducted by the U.S. Centers for Disease Control and Prevention between 1987 and 2010. The researchers compared this information with macroeconomic data on state unemployment rates and annual per capita income from the U.S. Department of Labor Statistics.
After controlling for per capita personal income, use of preventive services declined with increased unemployment, especially for working age adults. A smaller decrease was seen in people over age 65, who are usually covered by Medicare. Women and people who are already economically disadvantaged were especially sensitive to economic fluctuations.
Preventive medical care is underutilized in the United States, with only about half of the population following recommended guidelines, note the researchers. Furthermore, they suggest, preventive care can carry a relatively high one-time cost and may be more likely to be seen as a relative luxury, therefore changes in income, or fears of an impending loss of income during a downturn, may have a greater effect on their use.
Health care providers should consider factors such as economic downturns when advising patients about preventive care or exams to ensure that they make the best choices, the researchers say.
"If patients are under financial or other distress and decide that they need to forego some treatments, then their doctor could play a crucial role in helping them think through that decision," Tefft said.
These results validate what public health professionals already know, said Georges C. Benjamin, M.D., executive director of the American Public Health Association in Washington. "We know that having less income automatically reduces one's access to services for a variety of reasons." People put off non-emergency health decisions when money is tight, he noted. "Unless people perceive a problem to be an emergency, they are less likely to have it taken care of."
Source: The University of Washington