Should I Get a Flu Shot?

Is it rational to get a flu shot? I had to go to the doctor recently, and while I was there they offered, and I accepted, a flu shot. Then I found out my insurance doesn’t pay for it.

I know the arguments in favor of getting the shot, which are fairly self-evident and persuasive. But if my insurance company is willing to take the risk of paying for my health care if I get sick, but not for the shot itself, then it appears the shot has a lower expected value than not getting the shot.

Or is the flu an illness where the insurance carrier covers comparatively little cost, because it is viral and they won’t have to cover the cost of medicine and the odds of hospitalization are low, while the ill person, of course, pays the cost of being horribly miserable?

Obviously there’s a collective action problem here as well. There’s some critical mass of immunizations that will make it unlikely that very many people at all get the flu, and my decision to get the shot won’t be the critical contribution, so there’s some logic to free riding. But I’m more interested here in comparing my personal EV to the insurance company’s EV calculation. Do they know something I don’t know?


About J@m3z Aitch

J@m3z Aitch is a two-bit college professor who'd rather be canoeing.
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17 Responses to Should I Get a Flu Shot?

  1. Pinky says:

    James wrote, “But if my insurance company is willing to take the risk of paying for my health care if I get sick, but not for the shot itself, then it appears the shot has a lower expected value than not getting the shot.”

    What is the choice being made here?

    It’s a gamble the insurance company is making. Will it cost them less to treat the people that seek medical care once they get the flu or will it cost them more to pay for the flu shots?

    That’s an easy one to figure out.

    You sure didn’t think the insurance company cared about your health, did you?

  2. Scott Hanley says:

    Well, since many insurance companies will cover Viagra, but not contraception, you might be attributing too much rationality to their behavior.

  3. James Hanley says:

    Pinky, But my question is, if it’s rational for them to take that gamble, can we conclude that it’s rational for me to take that gamble (and, hence, irrational for me to get the shot)?

    Or are there different cost factors that ought to weigh into my expected value calculation that they don’t have to consider in there EV calculation?

    No, I don’t think they care about my health.

  4. Does it have something to do with whether the flu shot actually prevents getting the flu? I understand (perhaps wrongly) that each year’s flu vaccine is designed to combat the particular strain of flu most common that particular year and not, say, other flu strains that are also common, although not as dominant as the strain for which the vaccine is given.

    I also wonder if it is assumed that a lot of public-service-like drives–at pharmacies, at public health clinics–to offer free or reduced price flu shots might take up some of the slack for distributing the shots.

  5. D.A. Ridgely says:

    Clearly, you should exhort everyone else to get a flu shot while abstaining, yourself.

  6. Michael Heath says:

    My gut reaction is that your health insurance company is betting that even if you and similarly covered beneficiaries do get the flu, you won’t collectively consume more medical treatment than the cost of immunization coverage. I think this is a no-brainer reaction though defectively shallow.

    A more considered position would have one calculating the costs the health insurance industry covers collectively given that a minority of people do suffer tragic health consequences from catching the flu. So if the industry covered getting the shots, would it help create an environment where people felt sufficient cultural pressure to get immunized and therefore greatly decrease the rate of epidemics? What would be the return of such; would the costs of mass immunization reduce the collective costs of pay-outs for those few who did require medical treatment, some of whom have serious complications?

    I always get a flu shot for two reasons. One is of course to immunize myself though the more important reason is to prevent someone catching the flu from me. I was particularly concerned about novel viruses and the threat they pose to young people.

    I thought last year’s marketing efforts encouraging people to get immunized for the H1N1 shot, which didn’t have any out-of-pocket costs, was less than compelling. I would hope encouraging people to get the shot to protect their loved ones and others in general would have motivated people more than protecting themselves. However the marketing that reached my eyes and ears focused exclusively on trying to motivate me out of personal interest. It reminded me of how so many people vote for who they think will best support their personal interests rather than best effect improvements collectively.

  7. Michael Heath says:

    James Hanley, “Or are there different cost factors that ought to weigh into my expected value calculation that they don’t have to consider in there EV calculation?”

    Sorry I didn’t comprehend your original point. The reason I noted that I’m more compelled to get a shot for others than myself is because when I’ve caught the flu the symptoms are rarely miserable and it’s always nice to have an excuse for a couple of stay-at-home sick days a year. Therefore I’m perceiving some of the preventable cost (catching the flu) as a possible benefit.

    That might not be a very well-thought out position, in fact it’s not at all and slightly embarrassing revealing it, but I tend to worry more about abstract things than these sorts of issues – often to my wife’s ire.

  8. James Hanley says:

    DAR–Exhortation is costly. I should hope others do the exhorting to get yet others to get their flu shots, while I free-ride on the efforts of both the exhorters and the exhortees.

    Michael Heath–I think you’re confusing one of the many viral infections we commonly call “the flu,” which aren’t really, and aren’t the target of the flu shot, with the real thing, one of the various influenza strains. Or so I’ve been told is the case.

    My thinking is that because influenza is a viral infection, there are no medications to treat it. Bed rest and keeping yourself hydrated are the basic treatments (my understanding is that dehydration is the real killer of influenza, due to vomiting and diarrhea). If there are no medications, there’s little cost to the insurance company if I get sick. Unless, that is, I get sick enough–usually from dehydration, again, so I’ve heard–to go to the hospital. But the odds of that are low.

    So influenza seems a low cost disease from the insurance company’s perspective. Unless I’m missing something.

    But it’s not necessarily low cost for me. There are missed work days (well, not that this costs me anything, but I’m fortunate), and of course the disutility of the unpleasantness of being very ill.

  9. D.A. Ridgely says:

    Personally, I think you’ve got crappy insurance.

    It’s true that at your age, assuming you are in generally good health, there is little risk to you from contracting the flu and only palliative treatment, anyway. As one gets older, however, the symptoms are more serious and, more importantly, there is a far greater likelihood of life threatening opportunistic infections.

    Presumably, your insurer also insures older people and people with compromised immune systems and if you contract the flu you could well end up passing it on to them. (Remember, the vaccine is not 100% effective.)

    So there are both ethical and prudential reasons why people in general should be vaccinated and prudential (as well as ethical) reason why insurance companies should cover the costs.

  10. James Hanley says:

    Actually we have pretty good insurance. So not covering the shot surprised me, which is what got me to thinking about why.

    Assuming my insurer doesn’t operate based on ethics, which I think is a safe bet, they must have determined that the prudential reasons don’t add up financially. But I hadn’t thought about older people with compromised immune systems. They’re more likely to end up in the hospital due to influenza, and just one hospitalization would seem to cover a few truckloads of the vaccine.

    Maybe my brother was right, and I’m overestimating the insurance company’s rationality.

  11. James K says:

    I do get a flu vaccine every year, but then my employer pays for it. Plus, Wellington was one of the major global hotspots for Swine Flu, so it was a good idea to get one this year in particular.

    Michael Heath:

    The reason I noted that I’m more compelled to get a shot for others than myself is because when I’ve caught the flu the symptoms are rarely miserable and it’s always nice to have an excuse for a couple of stay-at-home sick days a year.

    That’s not influenza, that’s a cold or something. If it doesn’t make you want to die, it’s not the ‘flu.

  12. Scott S. says:

    James K.: Actually, according to what I’ve read, the flu can be mild. Most years that I get the flu, I am in a state of good health and notice it fairly early (being tuned by my family a bit more toward hypochondria than away from it). I stay home from work immediately, sleep all I can, and hydrate myself like I’m going on a marathon in the Sahara. That usually knocks it out in 2-3 days with only a mild fever.

    Last year I got the flu when my hay fever was bad (earlier than the seasonal flu, which probably indicates it was H1N1), so I was more susceptible to infection. It lasted a week and made me want to lock myself in a freezer–or an oven, alternately, depending on chills or sweats–so I could die comfortably.

  13. AMW says:

    Do they know something I don’t know?

    Yeah, they know that vaccines will give you autism and make you grow a third testicle, and they don’t want you knocking on their door with a lawsuit!

  14. AMW says:

    …make you grow a third testicle…

    Even if you’re a woman.

  15. James Hanley says:

    make you grow a third testicle,

    Is that a problem?

    So someone who’s told to “grow a pair” should get two flu shots?

    If I get a flu shot every year, just how many testicles would I end up with?

  16. AMW says:

    Probably the third one just keeps getting bigger.

  17. D. C. Sessions says:

    There’s another aspect to their calculation that you’ve left out: their downside (especially this year) is reduced because people like you and me get the shot out of pocket anyway. Thus, their risk pool is reduced to those who will forgo the shot due to lack of coverage.

    So their downside incremental risk comes to (those who decide to not get the shot because of cost)*(the fraction of unvaccinated who get the flu)*(the fraction of those who get the flu and are sick enough to need hospitalization)*(cost of hospitalization)

    Both the first and second parts are relatively low this year thanks to last year’s high profile pandemic: fewer people will skip the shot for cost, and coverage is high and therefore risk relatively low. Individuals aren’t the only free-riders out there.

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