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State-Level Unemployment and the Utilization of Preventive Medical Services

Keywords: Preventive health services;unemployment;economic conditions

Objective: To study the association between macroeconomic conditions and preventive medical service utilization.

Data Sources/Study Setting: Secondary data collection of a survey of the civilian, non-institutionalized population of adults (age 18 and older) in the United States between 1987 and 2010.

Study Design: Regression analyses that adjust for individual-level demographic and socioeconomic determinants, state and time-fixed effects, and state-specific time trends.

Data Collection/Extraction Methods: State health departments, with technological and methodological assistance from the Centers for Disease Control and Prevention, conducted a cross-sectional yearly telephone survey using a standardized questionnaire.

Principal Findings: The use of preventive medical services is procyclical: a 1 percentage point increase in the state-level unemployment rate is associated with a 1.58 percent decrease in the quantity of distinct preventive care services utilized. Women and economically disadvantaged populations are shown to be especially sensitive to macroeconomic fluctuations.

Conclusions: Policy makers should be aware of cyclical changes in preventive care use, particularly among disadvantaged populations, when making challenging budgetary decisions during economic downturns. As physician recommendations can have a strong impact on patients' use, health care providers could increase efforts to persuade patients to seek screening exams and necessary vaccinations during periods of high unemployment.

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