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Vaccination Rates are Associated With Functional Proximity But Not Base Proximity of Vaccination Clinics

Beshears, John PhD; Choi, James J. PhD; Laibson, David I. PhD; Madrian, Brigitte C. PhD; Reynolds, Gwendolyn I. MTS

doi: 10.1097/MLR.0000000000000523
Brief Report

Background: Routine annual influenza vaccinations are recommended for persons 6 months of age and older, but less than half of US adults get vaccinated. Many employers offer employees free influenza vaccinations at workplace clinics, but even then take-up is low.

Objective: To determine whether employees are significantly more likely to get vaccinated if they have a higher probability of walking by the clinic for reasons other than vaccination.

Method: We obtained data from an employer with a free workplace influenza vaccination clinic. Using each employee’s building entry/exit swipe card data, we test whether functional proximity—the likelihood that the employee walks by the clinic for reasons other than vaccination—predicts whether the employee gets vaccinated at the clinic. We also test whether base proximity—the inverse of walking distance from the employee’s desk to the clinic—predicts vaccination probability.

Participants: A total of 1801 employees of a health benefits administrator that held a free workplace influenza vaccination clinic.

Results: A 2 SD increase in functional proximity is associated with a 6.4 percentage point increase in the probability of vaccination (total vaccination rate at company=40%), even though the average employee’s desk is only 166 meters from the clinic. Base proximity does not predict vaccination probability.

Conclusions and Relevance: Minor changes in the environment can have substantial effects on the probability of vaccination. If these results generalize, health systems should emphasize functional proximity over base proximity when locating preventive health services.

*Harvard Business School, Harvard University and National Bureau of Economic Research, Boston, MA

Yale University and National Bureau of Economic Research, New Haven, CT

Department of Economics

§Harvard Kennedy School, Harvard University and National Bureau of Economic Research

National Bureau of Economic Research, Cambridge, MA

The findings and conclusions expressed are solely those of the authors and do not represent the views of the NIH or the NBER.

D.I.L. has served as a member of the Express Scripts Scientific Advisory Board since 2008. In 2010, D.I.L. donated all of these proceeds to charity. Since 2011, Express Scripts has directly donated to charity all compensation that he would have received. The remaining authors declare no conflict of interest.

Reprints: Gwendolyn I. Reynolds, MTS, National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138. E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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