Gaps in Vaccine Financing for Underinsured Children in the United States

Abstract

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.

Financing the Delivery of Vaccines to Children and Adolescents: Challenges to the Current System

“…Several states have needed to scale back vaccination programs to exclude children on the basis of their insurance status. [27][28][29] In the public sector, the VFC safety net is assigned to FQHCs/RHCs rather than to health departments, the traditional health care safety-net provider. FQHCs and RHCs have limited capacity and geographic reach and represent Ͻ10% of VFC providers.…”

“…10 This has led to 2-tiered vaccine-financing systems in many states, under which the set of publicly purchased vaccines provided to underinsured children is not the same as the set provided to other VFC-eligible children. 29 The ultimate effect of 2-tiered systems is de facto prioritization of vaccines not on the basis of the benefits of vaccination but on the basis of insurance status. 28 Children who are eligible for VFC in any setting and privately insured children with full vaccination benefits are vaccinated as soon as their insurance coverage takes effect.…”

“…28,29 State immunization officials are reluctant to implement 2-tiered vaccination programs. Some states may delay implementation of newly recommended vaccines in the public sector until they are able to finance vaccines for underinsured as well as VFCeligible children.…”

Maintaining the Vaccine Safety Net

“…3 At least 13 states have changed their policies regarding provision of publicly purchased vaccines since 2004 and now restrict access to selected vaccines. 4 Although national immunization coverage rates are still high, this patchwork of vaccine-financing structures shows our increasing vulnerability. The risks associated with neglect to our public health immunization system are high and have been demonstrated.…”

“…3 At least 13 states have changed their policies regarding provision of publicly purchased vaccines since 2004 and now restrict access to selected vaccines. 4 The cost to vaccinate a child fully has increased 653% over the past 8 years, although federal funding for vaccine purchases through the Section 317 program has remained essentially the same. 5 Although national immunization coverage rates are still high, this patchwork of vaccine-financing structures shows our increasing vulnerability.…”