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The Effect of Macroeconomic Conditions on the Care Decisions of the Employed

Hughes, Danny R., PhD*,†; Khaliq, Amir A., PhD

doi: 10.1097/MLR.0000000000000051
Original Articles

Background: Medical care utilization has been found to be affected indirectly by changes in economic conditions through associated changes in employment or insurance status. However, if individuals interpret external macroeconomic conditions as employment risk, they may alter decisions to seek care even if they remain both employed and insured.

Objective: To examine the relationship between macroeconomic fluctuations and the medical care usage of Americans who are both employed and insured.

Research Design: Restricting the Medical Expenditure Panel Survey from 1995 to 2008 to respondents whose employment status and insurance status did not change, we employed a fixed-effect Poisson model to examine the association between state average annual unemployment rates and the utilization of 12 medical services.

Results: The average annual state unemployment rate was found to be a significant factor in hospital outpatient visits (P < 0.01) and emergency room visits (P < 0.01). A one percentage point increase in the unemployment rate was found to produce an additional 0.67 hospital outpatient visits and 0.14 emergency room visits.

Conclusions: State unemployment rates were found statistically significantly associated with several of the medical services studied, suggesting macroeconomic conditions are an important factor in the medical decisions of employed and insured individuals. Thus, policy changes that increase access among the unemployed or uninsured may mitigate this employment risk effect and create incentives that potentially alter the utilization decisions among those currently both employed and insured.

*Harvey L. Neiman Health Policy Institute, Reston

Department of Health Administration and Policy, George Mason University, Fairfax, VA

Department of Health Administration and Policy, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK

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The research in this paper was conducted at the CFACT Data Center and the support of the Agency for Healthcare Research and Quality (AHRQ) is acknowledged. The results and conclusions in this paper are those of the authors and do not indicate concurrence by AHRQ or the Department of Health and Human Services.

The authors declare no conflict of interest.

Reprints: Danny R. Hughes, PhD, Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191. E-mail:

© 2014 by Lippincott Williams & Wilkins.