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Vaccines at Work

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  • Hoffmann, Manuel

    (Texas A&M University)

  • Mosquera, Roberto

    (Universidad de las Américas)

  • Chadi, Adrian

    (University of Konstanz)

Abstract

Influenza vaccination could be a cost-effective way to reduce costs in terms of human lives and productivity losses, but low take-up rates and vaccination unintentionally causing moral hazard may decrease its benefits. We ran a natural field experiment in cooperation with a bank in Ecuador, where we modified its vaccination campaign. Experimentally manipulating incentives to participate in this health intervention allows us to study peer effects with organizational data and to determine the personal consequences of being randomly encouraged to get vaccinated. We find that assigning employees to get vaccinated during the workweek roughly doubled take-up compared to employees assigned to the weekend, which indicates that reducing opportunity costs plays an important role in increasing vaccination rates. Coworker take-up also increased individual take-up significantly and is driven by social norms. Contrary to the company's expectation, vaccination did not reduce sickness absence during the flu season. Getting vaccinated was ineffective with no measurable health externalities from coworker vaccination. We rule out meaningful individual health effects when considering several thresholds of expected vaccine effectiveness. Using a dataset of administrative records on medical diagnoses and employee surveys, we find evidence consistent with vaccination causing moral hazard, which could decrease the effectiveness of vaccination.

Suggested Citation

  • Hoffmann, Manuel & Mosquera, Roberto & Chadi, Adrian, 2020. "Vaccines at Work," IZA Discussion Papers 12939, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp12939
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    1. Anderson, Michael L, 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Department of Agricultural & Resource Economics, UC Berkeley, Working Paper Series qt15n8j26f, Department of Agricultural & Resource Economics, UC Berkeley.
    2. Michael Kremer & Edward Miguel, 2007. "The Illusion of Sustainability," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(3), pages 1007-1065.
    3. Ryoko Sato & Yoshito Takasaki, 2019. "Psychic vs. Economic Barriers to Vaccine Take-Up: Evidence from a Field Experiment in Nigeria," The World Bank Economic Review, World Bank, vol. 33(3), pages 622-642.
    4. Philipp Ager & Casper Worm Hansen & Peter Sandholt Jensen, 2018. "Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden," Journal of the European Economic Association, European Economic Association, vol. 16(2), pages 487-521.
    5. Liran Einav & Amy Finkelstein & Stephen P. Ryan & Paul Schrimpf & Mark R. Cullen, 2013. "Selection on Moral Hazard in Health Insurance," American Economic Review, American Economic Association, vol. 103(1), pages 178-219, February.
    6. Belot, Michèle & James, Jonathan & Nolen, Patrick, 2016. "Incentives and children's dietary choices: A field experiment in primary schools," Journal of Health Economics, Elsevier, vol. 50(C), pages 213-229.
    7. Oster, Emily, 2018. "Does disease cause vaccination? Disease outbreaks and vaccination response," Journal of Health Economics, Elsevier, vol. 57(C), pages 90-101.
    8. Jonathan Klick & Thomas Stratmann, 2007. "Diabetes Treatments and Moral Hazard," Journal of Law and Economics, University of Chicago Press, vol. 50(3), pages 519-538.
    9. Ziebarth, Nicolas R. & Karlsson, Martin, 2010. "A natural experiment on sick pay cuts, sickness absence, and labor costs," Journal of Public Economics, Elsevier, vol. 94(11-12), pages 1108-1122, December.
    10. Geoffard, Pierre-Yves & Philipson, Tomas, 1997. "Disease Eradication: Private versus Public Vaccination," American Economic Review, American Economic Association, vol. 87(1), pages 222-230, March.
    11. Glenn W. Harrison & John A. List, 2004. "Field Experiments," Journal of Economic Literature, American Economic Association, vol. 42(4), pages 1009-1055, December.
    12. Corey White, 2021. "Measuring Social and Externality Benefits of Influenza Vaccination," Journal of Human Resources, University of Wisconsin Press, vol. 56(3), pages 749-785.
    13. Lawler, Emily C., 2017. "Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine," Journal of Health Economics, Elsevier, vol. 52(C), pages 45-62.
    14. Salvanes, Kjell G, 2018. "Disease Control and Inequality Reduction: Evidence from a Tuberculosis Testing and Vaccination Program," CEPR Discussion Papers 13061, C.E.P.R. Discussion Papers.
    15. Alexandre Mas & Enrico Moretti, 2009. "Peers at Work," American Economic Review, American Economic Association, vol. 99(1), pages 112-145, March.
    16. David S. Lee, 2009. "Training, Wages, and Sample Selection: Estimating Sharp Bounds on Treatment Effects," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 76(3), pages 1071-1102.
    17. Anderson, Michael L., 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Journal of the American Statistical Association, American Statistical Association, vol. 103(484), pages 1481-1495.
    18. Hoffman, Elizabeth & McCabe, Kevin & Smith, Vernon L, 1996. "Social Distance and Other-Regarding Behavior in Dictator Games," American Economic Review, American Economic Association, vol. 86(3), pages 653-660, June.
    19. José Luis Montiel Olea & Carolin Pflueger, 2013. "A Robust Test for Weak Instruments," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 31(3), pages 358-369, July.
    20. Robert Nuscheler & Kerstin Roeder, 2016. "To Vaccinate or to Procrastinate? That is the Prevention Question," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1560-1581, December.
    21. John A. List & Robert D. Metcalfe & Michael K. Price & Florian Rundhammer, 2017. "Harnessing Policy Complementarities to Conserve Energy: Evidence from a Natural Field Experiment," NBER Working Papers 23355, National Bureau of Economic Research, Inc.
    22. Sam Peltzman, 2011. "Offsetting Behavior, Medical Breakthroughs, and Breakdowns," Journal of Human Capital, University of Chicago Press, vol. 5(3), pages 302-341.
    23. Daniel Kahneman & Amos Tversky, 2013. "Prospect Theory: An Analysis of Decision Under Risk," World Scientific Book Chapters, in: Leonard C MacLean & William T Ziemba (ed.), HANDBOOK OF THE FUNDAMENTALS OF FINANCIAL DECISION MAKING Part I, chapter 6, pages 99-127, World Scientific Publishing Co. Pte. Ltd..
    24. Bronchetti, Erin Todd & Huffman, David B. & Magenheim, Ellen, 2015. "Attention, intentions, and follow-through in preventive health behavior: Field experimental evidence on flu vaccination," Journal of Economic Behavior & Organization, Elsevier, vol. 116(C), pages 270-291.
    25. Maurer, Jürgen, 2009. "Who has a clue to preventing the flu? Unravelling supply and demand effects on the take-up of influenza vaccinations," Journal of Health Economics, Elsevier, vol. 28(3), pages 704-717, May.
    26. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
    27. Margolis, Jesse & Hockenberry, Jason & Grossman, Michael & Chou, Shin-Yi, 2014. "Moral Hazard and Less Invasive Medical Treatment for Coronary Artery Disease: The Case of Cigarette Smoking," IZA Discussion Papers 8492, Institute of Labor Economics (IZA).
    28. Charles F. Manski, 1993. "Identification of Endogenous Social Effects: The Reflection Problem," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 60(3), pages 531-542.
    29. Aline Bütikofer & Meghan M. Skira, 2018. "Missing Work Is a Pain: The Effect of Cox-2 Inhibitors on Sickness Absence and Disability Pension Receipt," Journal of Human Resources, University of Wisconsin Press, vol. 53(1), pages 71-122.
    30. Hendrik Schmitz & Ansgar Wübker, 2011. "What determines influenza vaccination take‐up of elderly Europeans?," Health Economics, John Wiley & Sons, Ltd., vol. 20(11), pages 1281-1297, November.
    31. Carlisle Rainey, 2014. "Arguing for a Negligible Effect," American Journal of Political Science, John Wiley & Sons, vol. 58(4), pages 1083-1091, October.
    32. Katherine L. Milkman & John Beshears & James J. Choi & David Laibson & Brigitte C. Madrian, 2011. "Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates," NBER Working Papers 17183, National Bureau of Economic Research, Inc.
    33. Auld, M. Christopher, 2003. "Choices, beliefs, and infectious disease dynamics," Journal of Health Economics, Elsevier, vol. 22(3), pages 361-377, May.
    34. Kjetil Bjorvatn & Alexander W. Cappelen & Linda Helgesson Sekei & Erik Ø. Sørensen & Bertil Tungodden, 2020. "Teaching Through Television: Experimental Evidence on Entrepreneurship Education in Tanzania," Management Science, INFORMS, vol. 66(6), pages 2308-2325, June.
    35. List, John A. & Samek, Anya Savikhin, 2015. "The behavioralist as nutritionist: Leveraging behavioral economics to improve child food choice and consumption," Journal of Health Economics, Elsevier, vol. 39(C), pages 135-146.
    36. Ali Moghtaderi & Avi Dor, 2016. "Immunization and Moral Hazard: The HPV Vaccine and Uptake of Cancer Screening," NBER Working Papers 22523, National Bureau of Economic Research, Inc.
    37. George A. Akerlof & Rachel E. Kranton, 2000. "Economics and Identity," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(3), pages 715-753.
    38. David R. Just & Joseph Price, 2013. "Using Incentives to Encourage Healthy Eating in Children," Journal of Human Resources, University of Wisconsin Press, vol. 48(4), pages 855-872.
    39. Lenisa V. Chang, 2018. "Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy," Health Economics, John Wiley & Sons, Ltd., vol. 27(7), pages 1043-1062, July.
    40. James H. Stock & Motohiro Yogo, 2002. "Testing for Weak Instruments in Linear IV Regression," NBER Technical Working Papers 0284, National Bureau of Economic Research, Inc.
    41. Erin Hartman & F. Daniel Hidalgo, 2018. "An Equivalence Approach to Balance and Placebo Tests," American Journal of Political Science, John Wiley & Sons, vol. 62(4), pages 1000-1013, October.
    42. Doleac, Jennifer & Mukherjee, Anita, 2018. "The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime," IZA Discussion Papers 11489, Institute of Labor Economics (IZA).
    43. Eduard Talamàs & Rakesh Vohra, 2018. "Go Big or Go Home: A Free and Perfectly Safe but Only Partially Effective Vaccine Can Make Everyone Worse Off," PIER Working Paper Archive 18-006, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania, revised 15 Jan 2018.
    44. Peltzman, Sam, 1975. "The Effects of Automobile Safety Regulation," Journal of Political Economy, University of Chicago Press, vol. 83(4), pages 677-725, August.
    45. Jessamyn Schaller & Lisa Schulkind & Teny Maghakian Shapiro, 2017. "The Effects of Perceived Disease Risk and Access Costs on Infant Immunization," NBER Working Papers 23923, National Bureau of Economic Research, Inc.
    46. Christopher S. Carpenter & Emily C. Lawler, 2019. "Direct and Spillover Effects of Middle School Vaccination Requirements," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 95-125, February.
    47. Alma Cohen & Liran Einav, 2003. "The Effects of Mandatory Seat Belt Laws on Driving Behavior and Traffic Fatalities," The Review of Economics and Statistics, MIT Press, vol. 85(4), pages 828-843, November.
    48. Courtney J. Ward, 2014. "Influenza Vaccination Campaigns: Is an Ounce of Prevention Worth a Pound of Cure?," American Economic Journal: Applied Economics, American Economic Association, vol. 6(1), pages 38-72, January.
    49. Brito, Dagobert L. & Sheshinski, Eytan & Intriligator, Michael D., 1991. "Externalities and compulsary vaccinations," Journal of Public Economics, Elsevier, vol. 45(1), pages 69-90, June.
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    Cited by:

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    More about this item

    Keywords

    random encouragement design; field experiment; sickness-related absence; flu vaccination; health intervention; moral hazard; technology adoption;
    All these keywords.

    JEL classification:

    • D90 - Microeconomics - - Micro-Based Behavioral Economics - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J01 - Labor and Demographic Economics - - General - - - Labor Economics: General
    • N36 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Latin America; Caribbean

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