Article

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: 30.39). 09/2007; 298(6):638-43. DOI: 10.1001/jama.298.6.638
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Grace M Lee, Sep 05, 2015
0 Followers
 · 
132 Views
 · 
102 Downloads
  • Source
    • "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). "
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite record-high immunization coverage nationally, there is considerable variation across state and local immunization programs, which are responsible for the implementation of vaccine recommendations in their jurisdictions. The objectives of this study were to describe activities of state and local immunization programs that sustained high coverage levels across several years and to identify common themes and practical examples for sustaining childhood vaccination coverage rates that could be applied elsewhere. We conducted 95 semi-structured key informant interviews with internal staff members and external partners at the 10 immunization programs with the highest sustained childhood immunization coverage from 2000 to 2005, as measured by the National Immunization Survey. Interview transcripts were analyzed qualitatively using a general inductive approach. Common themes across the 10 programs included maintaining a strong program infrastructure, using available data to drive planning and decision making, a commitment to building and sustaining relationships, and a focus on education and communication. Given the challenges of an increasingly complex immunization system, the lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs.
    Journal of public health management and practice: JPHMP 01/2010; 16(1):E9-17. DOI:10.1097/PHH.0b013e3181c7e053 · 1.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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
Show more