Vaccine Financing For Underinsured Children - Gaps In Coverage
The authors write that "The number and cost of new vaccines routinely recommended for children and adolescents has increased considerably since 2003. New or expanded recommendations for meningococcal conjugate, tetanus-diphtheria-acellular pertussis (Tdap), hepatitis A, influenza, rotavirus, and human papillomavirus vaccines have led to a 7.5-fold increase in the cost to fully vaccinate a child in the public sector (from $155 in 1995 to $1,170 in 2007)."
Pediatric vaccines in the United States are funded by an assortment of public and private sources. According to some state policy makers and physicians, the new gaps have appeared in financial coverage of children who are underinsured. An underinsured child is one whose private insurance does not cover all recommended vaccines.
In the year 2000 about 1 in every 7 US children was underinsured for vaccines. These children's families either had to pay to make up for the shortfall or forego receiving vaccines.
Grace M. Lee, M.D., M.P.H., of Harvard Medical School, Children's Hospital Boston and Harvard Pilgrim Health Care, Boston, and team looked at the status of financing and distribution of new children's vaccines at the state level. The researchers then interviewed 9 immunization program managers as well as interviewing and surveying 48 state immunization program managers from January-June 2006.
Several states were not able to give state-purchased vaccines for these underinsured children in either the public sector, the private sector, or both.
Vaccines given in the private sector to underinsured children:
-- 46% of states did not provide publicly purchased chickenpox (varicella) vaccine
-- 70% of states did not provide publicly purchased meningococcal conjugate vaccine.
Vaccines given in the public sector to underinsured children:
-- 17% of states were unable to provide publicly purchased pneumococcal conjugate vaccine
-- 40% percent were unable to provide publicly purchased meningococcal conjugate vaccine
The authors wrote "This meant that underinsured children were not able to receive state-purchased vaccine in either the private or public sectors in these states. None of the vaccines we studied was covered for all underinsured children in the United States."
Ten states changed their policies regarding provision of publicly purchased vaccines between 2004-2006 because of limited financing of new vaccines - the new policies restricted access to new vaccines to selected underinsured children. The main barrier seems to have been a shortage of federal and state funding to purchase vaccines.
The authors added "Assuming 14 percent of children are underinsured in the United States, we estimate that 2.3 million children are unable to receive state-purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children are unable to receive this vaccine even if they are referred to the public sector. Current trends in health insurance products, including enrollment in high-deductible health plans that may or may not provide immunizations or other preventive benefits before a high deductible has been met, are likely to increase the magnitude of this gap and must be carefully monitored."
JAMA 2007;298(6):638-643
http://jama.ama-assn.org
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