 |
|
Gaps in Vaccine Financing for Underinsured Children in the United States
Grace M. Lee, MD, MPH;
Jeanne M. Santoli, MD;
Claire Hannan, MPH;
Mark L. Messonnier, PhD;
James E. Sabin, MD;
Donna Rusinak;
Charlene Gay;
Susan M. Lett, MD, MPH;
Tracy A. Lieu, MD, MPH
JAMA. 2007;298:638-643.
Context 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.
Objectives 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.
Design, Setting, and Participants 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.
Main Outcome Measures Percentage of states in which underinsured children are unable to receive publicly purchased vaccines in the private or public sectors.
Results 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.
Conclusions 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.
Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee, Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston, Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Reducing Financial Barriers to Vaccination in the United States: Call to Action
Birkhead et al.
Pediatrics 2009;124:S451-S454.
FULL TEXT
Financing Vaccines: Cornerstone of Prevention
Gellin and Shen
Pediatrics 2009;124:S457-S458.
FULL TEXT
Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations
Freed et al.
Pediatrics 2009;124:S466-S471.
ABSTRACT
| FULL TEXT
Underinsurance and Pediatric Immunization Delivery in the United States
Smith et al.
Pediatrics 2009;124:S507-S514.
ABSTRACT
| FULL TEXT
Underinsurance and Adolescent Immunization Delivery in the United States
Smith et al.
Pediatrics 2009;124:S515-S521.
ABSTRACT
| FULL TEXT
Financing the Delivery of Vaccines to Children and Adolescents: Challenges to the Current System
Lindley et al.
Pediatrics 2009;124:S548-S557.
ABSTRACT
| FULL TEXT
National Vaccine Advisory Committee 2008 Vaccine Financing Recommendations: Different Point of View
Abramson
Pediatrics 2009;124:S569-S570.
FULL TEXT
Maintaining the Vaccine Safety Net
Hannan et al.
Pediatrics 2009;124:S571-S572.
FULL TEXT
Financial Barriers to Implementing Combination Vaccines: Perspectives From Pediatricians and Policy Makers
Gidengil et al.
CLIN PEDIATR 2009;48:539-547.
ABSTRACT
Vaccine Financing in the United States: An Emerging Crisis
Lee and Lieu
Arch Pediatr Adolesc Med 2009;163:485-487.
FULL TEXT
Underinsurance of Adolescents: Recommendations for Improved Coverage of Preventive, Reproductive, and Behavioral Health Care Services
Committee on Adolescence and Committee on Child He
Pediatrics 2009;123:191-196.
ABSTRACT
| FULL TEXT
Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations
Freed et al.
Pediatrics 2008;122:1319-1324.
ABSTRACT
| FULL TEXT
Adolescent Immunizations: Missed Opportunities for Prevention
Lee et al.
Pediatrics 2008;122:711-717.
ABSTRACT
| FULL TEXT
Behavior in Early Adolescence and Risk of Human Papillomavirus Infection as a Young Adult: Results From a Population-Based Study
Dempsey et al.
Pediatrics 2008;122:1-7.
ABSTRACT
| FULL TEXT
WHO wants safer medicines for children
Choonara
Arch. Dis. Child. 2008;93:456-457.
FULL TEXT
HPV Vaccine: Immersed in Controversy
Ohri
The Annals of Pharmacotherapy 2007;41:1899-1902.
ABSTRACT
| FULL TEXT
Reasons and Remedies for Underinsurance for Child and Adolescent Vaccines
Davis
JAMA 2007;298:680-682.
FULL TEXT
|
