Gaps in Vaccine Financing for Underinsured Children in the United States

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2007; 298(6):638-43. DOI: 10.1001/jama.298.6.638
Source: PubMed


The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (ie, have private insurance that does not cover all recommended vaccines). In 2000, approximately 14% of children were underinsured for vaccines in the United States.
To describe variation among states in the provision of new vaccines to underinsured children and to identify barriers to state purchase and distribution of new vaccines.
A 2-phase mixed-methods study of state immunization program managers in the United States. The first phase included 1-hour qualitative telephone interviews conducted from November to December 2005 with 9 program managers chosen to represent different state vaccine financing policies. The second phase incorporated findings from phase 1 to develop a national telephone and paper-based survey of state immunization program managers that was conducted from January to June 2006.
Percentage of states in which underinsured children are unable to receive publicly purchased vaccines in the private or public sectors.
Immunization program managers from 48 states (96%) participated in the study. Underinsured children were not eligible to receive publicly purchased meningococcal conjugate or pneumococcal conjugate vaccines in the private sector in 70% and 50% of states, respectively, or in the public sector in 40% and 17% of states, respectively. Due to limited financing for new vaccines, 10 states changed their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict access to selected new vaccines for underinsured children. The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines.
The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors. Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population.

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    • "Regardless of what criteria are used to define underinsurance, people who are underinsured often find themselves facing a myriad of challenges (Silverman, 2008). For example, one recent study (Collins, Kriss, Doty, & Rustgi, 2008) demonstrated that underinsured persons frequently postpone or forgo recommended health care or cut back on needed prescription medications because of costs, while another study (Lee et al., 2007) showed that underinsured children tend to forego needed vaccinations. Many underinsured people incur substantial medical debt (Evans, 2008) that, in extreme cases, can force them into bankruptcy (Himmelstein, Warren, Thorne, & Woolhandler, 2005; Raiz, 2006). "

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