中文摘要
本文评估COVID-19疫苗接种对个体延迟或放弃就医倾向的影响。我们的研究设计利用各州及不同时期按年龄逐步开放疫苗接种资格所产生的、可合理视为外生的变动，作为个体疫苗接种状态的工具变量。我们发现，接种COVID-19疫苗使因任何医疗状况而延迟就医的可能性降低37%。此外，我们的分析表明，父母获得疫苗接种资格会使儿童延迟或放弃就医的可能性在统计上显著降低，表明家庭内部存在超出感染防护作用的正向健康溢出效应。我们的分析还显示，疫苗接种减少了人们对感染或传播COVID-19的担忧，从而增加了人员流动，并可能减少延迟或回避就医的行为。此外，我们发现，疫苗接种明显增加了获得择期诊疗和手术的机会，但对急诊收治、精神健康病例或其他医疗状况没有统计显著的影响。我们的结果凸显了疫苗的重要作用：不仅能够预防冠状病毒感染，还能防止因延迟或放弃就医而导致的健康状况恶化。疫苗接种带来的延迟或放弃就医的减少，在少数族裔和社会经济地位较低的人群中尤为明显，表明疫苗接种工作能够在缩小健康和医疗服务方面的不平等中发挥重要作用。在补充分析中，我们利用借记卡和信用卡支出的新数据表明，疫苗接种率提高对短期消费者医疗支出具有正向影响，但该影响不具有统计显著性。综合来看，我们的研究结果意味着，疫苗研发的进步与能够安全地加速向公众提供疫苗的监管程序相结合，可以带来额外益处，即在公共卫生危机期间帮助满足尚未得到满足的医疗需求。
Abstract
Abstract This paper evaluates the effect of COVID-19 vaccination on the individual propensity to delay or skip medical care. Our research design exploits the arguably exogenous variation in age-specific vaccine eligibility rollout across states and over time as an instrument for individual vaccination status. We find that receiving a COVID-19 vaccine reduces the likelihood of delaying care for any medical condition by 37%. Furthermore, our analysis reveals that children are significantly less likely to delay or skip healthcare as a result of their parents becoming vaccine eligible, indicating the presence of a positive health spillover within households that extends beyond protection against infection. Our analysis also shows that vaccination reduces concerns about contracting or spreading COVID-19, leading to increased mobility and potentially reducing delays or avoidance in seeking healthcare. Additionally, we find that vaccination notably increased access to elective care and surgeries, but had no significant impact on emergency department admissions, mental health cases or other medical conditions. Our results highlight the important role that vaccines play in, not only protecting against coronavirus, but also safeguarding against the worsening of health due to delayed or foregone medical care. The decline in delayed or foregone care caused by vaccination is particularly strong among minorities and those with a low socioeconomic background, revealing an important role that vaccination efforts can play in narrowing inequities in health and healthcare. In supplementary analysis, we use novel data on debit and credit card spending to demonstrate that increased vaccine uptake has a positive, albeit statistically insignificant, effect on consumer healthcare spending in the short run. Taken together, our findings imply that advancements in vaccine development coupled with a regulatory process that accelerates the availability of vaccines to the public in a safe manner can have the additional benefit of tackling unmet healthcare needs during a public health crisis.