title: The effect of macroeconomic conditions on the care decisions of the employed.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: *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.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.forename: Amir A
authors.initials: AA
authors.lastname: Khaliq
mesh_terms: D000328:Adult; D000367:Age Factors; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D057172:Economic Recession / Q000706:statistics & numerical data; D004467:Economics / Q000706:statistics & numerical data; D004651:Employment / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology