Free Employee Flu Shots Pay Prevention Dividends

By Donna E. Shalala
January 27, 2012 | Commentary

As is the case every year, millions of Americans will contract influenza this flu season, and thousands will die. During the 2009–10 season alone, when H1N1 set off the world’s first flu pandemic in 40 years, more than an estimated 12,000 Americans lost their lives to the new and different respiratory virus or its complications.

Among them was an unborn child whose heart stopped beating minutes after she was delivered by emergency C-section at a South Florida hospital. The baby’s mother, Aubrey Opdyke, spent 3 months in the hospital fighting and recovering from a severe case of H1N1. She never had the chance to hold her second daughter.

Her tragedy is, thankfully, unusual. Most people who get the flu are miserable for a few days, but are able to return to work quickly. Still, according to the Centers for Disease Control and Prevention, the flu costs businesses an estimated $10.4 billion in direct costs for hospitalization and outpatient visits annually, and, according to a Harvard University study, typically $10 billion in lost productivity.

Humanitarian reasons aside, that’s why employers and insurers should provide annual flu vaccines to employees at no cost. That’s right—for free, with no copayment or deductible. Absorbing the cost of the vaccine, just under $10 in 2011, is a sound business practice that will more than pay for itself.

Why not just ask workers to cough up the measly $10? As I learned when I became secretary of the U.S. Department of Health and Human Services (HHS) in 1993, copayments and deductibles matter when people make health care decisions, especially for preventive measures they don’t consider essential.

Among my first challenges at HHS was convincing seniors to get an annual flu shot. At the time, fewer than 10 percent bothered. But since Medicare recipients had only a $10 copay for the shots, I assumed all we needed to do was spread the word about how vulnerable seniors are to the flu and how safe and effective the vaccines are.

It didn’t matter. Our public outreach campaign produced a negligible increase in the number of Medicare recipients who complied. Subsequent focus group discussions pinpointed the reason: The start of the federal fiscal year happened to coincide with flu season, which meant Medicare’s annual $100 deductible renewed at the same time.

As a result, cost-sensitive seniors were reluctant to start paying down their deductibles, even $10, for a “non-essential” prevention measure. They were “saving” their deductibles for something they  considered more important—like the antibiotics they would need if they contracted the flu.

So, we exempted flu shots from the deductible, and a significant percentage of the targeted seniors got their shots, saving Medicare a bundle. It is, after all, infinitely cheaper to prevent than treat the flu and its complications.

At the University of Miami, we had 6,000 vaccines on hand when flu season began last fall and we continue to encourage all employees, especially those who work in the health care sector, to avail themselves of one for free. We make it easy, offering the shots at health fairs and our walk-in health clinics, no appointment necessary.

Employers and insurers would be wise to do the same. They should be enticing the workforce into the front end of the health care system to take advantage of the kind of preventive care that could eliminate 80 percent of all disease. They should start with free flu shots that could spare their employees much misery, and maybe even save a life.

Considering the benefits, it is worth every penny. Just ask Aubrey Opdyke.



Suggested Citation

Shalala, D. E. 2012. Free Employee Flu Shots Pay Prevention Dividends. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC.

Author Information

Donna E. Shalala, the longest-serving secretary of the U.S. Department of Health and Human Services (1993–2001), is president of the University of Miami in Florida.

Conflict-of-Interest Disclosures

None disclosed.


The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.


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