Flu Shots

Alex Tabarrok gets his flu shot, and opines:

Marginal Revolution: Kiss me, I'm vaccinated: I just had my flu shot.  Please send your checks to my George Mason address. People who have the flu spread the virus so getting a flu shot not only reduces the probability that I will get the flu it reduces the probability that you will get the flu.  In the language of economics the flu shot creates an external benefit, a benefit to other people not captured by the person who paid the costs of getting the shot.  The external benefits of a flu shot can be quite large.  Under some conditions each person who is vaccinated reduces the expected number of other people who get the flu by 1.5.

Since a large fraction of the benefits of the flu shot, perhaps even a majority of the benefits, go to other people and not to the person paying the costs, the number of people who get a flu shot in the United States is well below the efficient level.  I only got the shot because, as you well know, I'm altruistic.  I care about you.  But do send your checks, that will help. In lieu of a check I'm thinking of having some buttons made up to encourage people to get their shot.  Here are some possible slogans:

• Kiss me, I'm vaccinated.
• Take one for the herd!
• Get a flu shot.  The life you save may not be your own.
• Madison Avenue here I come!

Of course, we know from the Coase Theorem that there is an alternative approach.  We could charge people who do not get their flu shots. (Thus, if you haven't had a shot you must still must send me a check.)  Or to reduce transaction costs we could fine people who get the flu.  I kind of like that last one.  (But what to do about the 36,000 a year who die from the flu - charge their estates?) What do you think?  Leave your suggestions/slogans for how to encourage getting a flu shot in the comments.

Yesterday we went to a church in Concord--Nuestra Señora Reina de Todos los Santos--where a visiting nurse was giving out flu shots in order to get my wife her flu shot. The person in line after her said that she was on Medical and didn't have to pay the $25 for the shot--and didn't have the money to pay the $25 in any case. But the Sutter Visiting Nurse Association apparently does not take Medi-Cal:

Flu Shot: Each year, Sutter Visiting Nurse Association (VNA) & Hospice offers flu shots and pneumonia shots at convenient local sites, in September, October, November, and December.

• Flu shot cost - $25.00
• With proof of Medicare Part B, we will bill Medicare for the cost of the vaccine

• Find a flu shot clinic near you

• Pneumonia vaccine - cost $35.00

• With proof of Medicare Part B, we will bill Medicare for the cost of the vaccine...

Note that people covered by Medi-Cal are NOT counted as among the 47 million uninsured.

Comments

[MattF]

How about a payment (from the insurance company that does the company health plan) to workplaces that give employees free flu shots?

[save_the_rustbelt]

The Medi-cal policy makes no sense, unless the county health departments are in charge of dispensing free doses. CA is always weird.
Or maybe SNVA has no provider agreement.

On the good news side the production and distribution system seems to have improved dramatically from a few years ago.

Physician offices are getting their supplies at the same time at grocery store clinics, now that is progress.

[Ken Houghton]

And here the guys on Airhead America radio (who noted that a large proportion of those alleged 36,000 are elderly who die not of the flu, but of the pneumonia they get after their body's defenses are weakened by influenza) claim that the pneumonia vaccine is less expensive than a flu shot.

[elliottg]

Overall, the flu shot is a good thing, but the marginal utility for healthy people to get the flu shot is blown way out of proportion when quoting mortality rates. It's the over-85 population that dies disproportionately. In this population, the vaccine is less effective due to their aging immune systems. In addition, death by influenza and pneumonia in this population masks choices (based on comorbidities) made by care providers and other decision makers(children and spouses) to let "nature take its course".

By all means, get the flu shot, but for healthy adults (and probably even children) without much contact with the elderly, it's probably not that important.

[Alex Tolley]

Again, why don't we have government paid healthcare, which would be especially effective for preventative, public health issues?

I'm reminded that even when we do have it, it is messed up. Remember the flu vaccine shortage a couple of years ago? Part of the problem is that instead of guaranteeing enough vaccines for everyone, the US govt allowed the suppliers to make what they thought was the most profitable amount. Like buying airline meals, this resulted in the inevitable shortfall of coverage.

[trotsky]

Medi-Cal payments are so low that providers lose money on every patient. (But make it up on volume!)

[David]

shouldn't all the people who did get flu shots too send Alex some money to compensate him for having made his shot less valuable? Of course he should send it back to them for getting a shot and making their shots less valuable!

[Joel]

Thin the herd. Don't get a flu shot.

[Bernard Yomtov]

So did anyone cough up, so to speak, the $25 so the MediCal patient could get the shot? Or did they give it to her anyway?

[tavella]

I was wondering that myself, Yomtov.

[tavella]

Also, the new blog design is terrible. Get rid of the widgetboxes -- you are filling the entire real estate of the main page with them. I didn't even realize for a while, as I was frustratedly clicking on entries, that the text was displayed below, because the widget boxes continued to be there.

And when you try to post a comment, you get a confirmation text matching question after you posted -- which shows up underneath the giant mass of the header, and nearly invisible. Really terrible design.

[MobiusKlein]

"Overall, the flu shot is a good thing, but the marginal utility for healthy people to get the flu shot is blown way out of proportion when quoting mortality rates."

Straight mortality is not the only measure to use. 1.5 fewer cases of a flu is nice. And those 1.5 are likely to be found among your close associates, not some far off corner of the galaxy.

To think of it concretely, what is the value to YOU of not getting sick with a flu this winter. If it's > $25, then you should be sure that all the citizens near you get that shot.

One hopes that a fully rational Economics Professor would act on this, but be too modest to crow. And then would lobby the CA state government to change the reimbursement rules.

[denise]

elliotg: the last time I had the flu I was 32, and I would have missed at least two weeks of work if I hadn't been unemployed at the time. I couldn't even stand up for 7 days. For people who can't come up with $25 for a shot, imagine the financial hardship this could cause.

[BillCross]

of course if the main types of influenza this winter are not in the group covered by the vaccine. This year's recommended vaccine is

* an A/Solomon Islands/3/2006 (H1N1)-like virus;
* an A/Wisconsin/67/2005 (H3N2)-like virus (A/Wisconsin/67/2005 (H3N2) and A/Hiroshima/52/2005 were used at the time);
* a B/Malaysia/2506/2004-like virus

These provide some resistance against similar viruses, but not complete coverage. In 2003/04 the time needed for vaccine manufacture meant that a new variant had become most common (A/Panama to A/Fujian).

Even when the vaccine is correct, it is not perfect -- in 2004/05 80% of the 84% of people with Influenza A were covered by the vaccine contents

[anonymous]

Even a flu shot that's 85% effective is better than not having one, which is 0% effective. It's an especially big deal if it's a variant that's really going to knock you out, which you've no way of knowing until you get it.

And it doesn't have to just be people directly in contact with the elderly or immunocompromised. The flu survives for 48 hours on hard sufaces. If it's widespread in the community, it becomes like mud on your shoe. It's easy for it to be tracked in with someone, even if that person is themselves vaccinated, and careful.

[Jannia]

"By all means, get the flu shot, but for healthy adults (and probably even children) without much contact with the elderly, it's probably not that important"

The last time I had the flu, it flattened me for nearly two weeks and left me seriously exhausted and coughing for about two more on top of that. I honestly can't remember the last time I was so miserable.

Fortunately, I'm salaried at a job with decent sick leave (and an official corporate policy of "Stay home! Don't share!"), so I got to spend the two weeks at home alternating between dozing and drugged unconscious. The thought of having to go through that while living hand to mouth ... it's worth the 25$.

[Ken Muldrew]

Tabarrok misses a third option which is explained nicely in Mancur Olsen's The_Logic_of_Collective_Action.