Financing the delivery of vaccines to children and adolescents: challenges to the current system.
ABSTRACT Recent increases in the number and costs of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current vaccine financing and delivery systems to maintain access to recommended vaccines without financial barriers. Here we review the current state of US financing for vaccine delivery to children and adolescents and identify challenges that should be addressed to ensure future access to routinely recommended vaccines without financial barriers. Challenges were considered from the perspectives of vaccine providers; state and local governments; insurers, employers, and other health care purchasers; vaccine manufacturers; and consumers.
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ABSTRACT: The market for pediatric vaccines is unusual in that more than half are publicly provided through the federal Vaccines for Children (VFC) program. The CDC negotiates with vaccine manufacturers for the purchase of all pediatric vaccines supplied under the program, and given the size of its purchases buys at significant discounts off of list prices on a per-dose basis. In contrast, bundled discounts are in widespread use by multi-vaccine manufacturers for pediatric vaccines sold for private use. In this paper, we consider the competitive implications of the use of these bundled discounts, and whether the practice is at odds with the public health goals of ensuring a stable vaccine supply and encouraging the development of new and improved pediatric vaccines.SSRN Electronic Journal 01/2012; DOI:10.2139/ssrn.1978879
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ABSTRACT: Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practices-recommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates. This was a qualitative study, using a literature review and semistructured expert interviews with payers. Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons. We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders.Public Health Reports 01/2011; 126(3):394-9. DOI:10.2307/41639376 · 1.64 Impact Factor
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ABSTRACT: Following the measles outbreaks of the late 1980s and early 1990s, vaccination coverage was found to be low nationally, and there were pockets of underimmunized children primarily in inner cities. We described the percentage and demographics of children who were entitled to the Vaccines for Children (VFC) program in 2009 and evaluated whether Healthy People 2010 (HP 2010) vaccination coverage objectives of 90% were achieved among these children. We analyzed data from 16,967 children aged 19-35 months sampled by the National Immunization Survey in 2009. VFC-entitled children included children who were (1) on Medicaid, (2) not covered by health insurance, (3) of American Indian/Alaska Native race/ethnicity, or (4) covered by private health insurance that did not pay all of the costs of vaccines, but who were vaccinated at a Federally Qualified Health Center or a Rural Health Center. An estimated 49.7% of all children aged 19-35 months were entitled to VFC vaccines. Compared with children who did not qualify for VFC, the VFC-entitled children were significantly more likely to be Hispanic or non-Hispanic black; to have a mother who was widowed, divorced, separated, or never married; and to live in a household with an annual income below the federal poverty level. Mothers of VFC-entitled children were significantly less likely to have some college experience or to be college graduates. Of nine vaccines analyzed, two vaccines--polio at 91.7% and hepatitis B at 92.2%--achieved the HP 2010 90% coverage objective for VFC-entitled children, and four others, including measles-mumps-rubella at 88.8%, achieved greater than 80% coverage. Conclusions. Today, children with demographic characteristics like those of children who were at the epicenter of the measles outbreaks two decades ago are entitled to VFC vaccines at no cost, and have achieved high vaccination coverage levels.Public Health Reports 01/2011; 126 Suppl 2(Suppl 2):109-23. DOI:10.2307/41639291 · 1.64 Impact Factor