title: State-level unemployment and the utilization of preventive medical services.
abstract: OBJECTIVE
  To study the association between macroeconomic conditions and preventive medical service utilization.
  
  
  METHODS
  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.
  
  
  METHODS
  Regression analyses that adjust for individual-level demographic and socioeconomic determinants, state and time-fixed effects, and state-specific time trends.
  
  
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Health Services, School of Public Health, and Department of Economics, College of Arts and Sciences, University of Washington, Seattle, WA, 98195-7660.
authors.forename: Nathan
authors.initials: N
authors.lastname: Tefft
authors.forename: Andrew
authors.initials: A
authors.lastname: Kageleiry
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014478:Unemployment / Q000706:statistics & numerical data*; D014481:United States
keywords: Preventive health services; economic conditions; unemployment