cover image: The Health and Employment Effects of Employer Vaccination Mandates

The Health and Employment Effects of Employer Vaccination Mandates

25 Oct 2024

Health care facilities considering mandating staff vaccination face a difficult tradeoff. While additional vaccination coverage will directly reduce disease transmission within the facility, the imposition of a mandate may also cause vaccine-hesitant staff to quit, which could harm patient care. To study this tradeoff, we leverage comprehensive administrative data covering virtually all US nursing homes, including payroll-based records on approximately 500 million daily nurse shifts and weekly data on COVID transmission and mortality at each facility. We use a difference-in-differences framework to estimate the impact of employer-imposed vaccine mandates at 581 nursing homes on disease spread, employment outcomes, and several patient care metrics. While mandates did slightly increase staff turnover, the effects were concentrated on staff working less than 20 hours per week, and resulted in a reduction of less than two minutes per patient-day. Furthermore, there is only limited evidence of lower levels of care at mandate facilities in typically-monitored conditions such as patient falls, pressure ulcers, or urinary tract infections. In contrast, implementing a vaccine mandate led to large increases in staff vaccinations at mandate facilities, which directly led to less transmission of and lower patient mortality from COVID. We estimate that vaccine mandates saved one patient life for every two facilities that enacted a mandate, a large effect given the typical facility has around 100 beds. Our results suggest that the health benefits of mandates far outweigh the costs in terms of reduced patient care from staff turnover.
health labor compensation labor economics labor studies labor supply and demand health, education, and welfare economics of aging economics of health

Authors

Ashvin Gandhi, Ian Larkin, Brian McGarry, Katherine Wen, Huizi Yu, Sarah Berry, Vincent Mor, Maggie Syme, Elizabeth White

Related Organizations

Brown University
Centers for Disease Control and Prevention
Harvard University
University of Michigan
University of Rochester
Acknowledgements & Disclosure
The primary research team included (alphabetical): Ashvin Gandhi, Ian Larkin, Brian McGarry, Katherine Wen, and Huizi Yu. Authors may list ordering however they deem appropriate. Under clinical journal conventions, Katherine Wen would be first author and Ashvin Gandhi would be last author. We thank Marion Aouad, David Gifford, David Grabowski, and Cyrus Kosar for helpful comments, as well as seminar and conference participants at Vanderbilt University, the National Bureau of Economics Research Summer Institute, the Midwest Healthcare Conference, and the American Society of Health Economics Annual Conference. This work was supported by a grant from the National Institute on Aging (U54AG063546). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
DOI
https://doi.org/10.3386/w33072
Pages
67
Published in
United States of America

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