How Might Immunization Rates Change if Cost Sharing is Eliminated?

Abstract

Objectives. There is a debate regarding the effect of cost sharing on immunization, particularly as the Affordable Care Act will eliminate cost sharing for recommended vaccines. This study estimates changes in immunization rates and spending associated with extending first-dollar coverage to privately insured children for four childhood vaccines.Methods. We used the 2008 National Immunization Survey and peer-reviewed literature to generate estimates of immunization status for each vaccine by age group and insurance type. We used the Truven Health Analytics 2006 MarketScan Commercial Claims and Encounters Database of line-item medical claims to estimate changes in immunization rates that would result from eliminating cost sharing, and we used the Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey to determine the prevalence of coverage for patients with first-dollar coverage, patients who face office visit cost sharing, and patients who face cost sharing for all vaccine cost components. We assumed that once cost sharing is removed, coverage rates in plans that impose cost sharing will rise to the level of plans that do not.results. We estimate that immunization rates would increase modestly and result in additional direct spending of $26.0 million to insurers/employers. Further, these payers would have an additional $11.0 million in spending associated with eliminating cost sharing for children already receiving immunizations.conclusions. The effects of eliminating cost sharing for vaccines vary by vaccine. Overall, immunization rates will rise modestly given high insurance coverage for vaccinations, and these increases would be more substantial for those currently facing cost sharing. However, in addition to the removal of cost sharing for immunizations, these findings suggest other strategies to consider to further increase immunization rates.

Vaccination Perceptions of College Students: With and without Vaccination Waiver

“…The barriers included in the study were personal adverse experiences or that of a parent or guardian, the associated out of pocket costs, fear/pain of needles, lack of transportation, risk of adverse event greater than perceived benefit, and for moral or religious reasons ( 25 , 26 ). To identify the cues to action ( 27 ), a construct of the Health Belief Model which identifies ways to activate willingness to engage in healthy preventive behaviors, we identified influencers such as educational material, low cost, ease of access, safe to use and administer vaccines, follow-up on compliance, and vaccination status of parent/guardian ( 28 ).…”

“…Other variables on the instrument included current vaccination status, which was the primary outcome of interest and sociodemographic characteristics such as gender, age, academic college in which enrolled, financial assistance status, current level of education, education level of parent/guardian, individual insurance status, regular access to primary care provider, and vaccine counseling and concerns related to vaccination leading to autism. We selected these sociodemographic characteristics based on available literature regarding vaccination trends ( 26 , 28 , 29 ). Vaccination waiver status was also measured.…”

The importance of immunization in cancer prevention, treatment, and survivorship

“…Approximately 50% of children aged <19 years are eligible to receive vaccines through the VFC, including those who are Medicaid‐eligible, uninsured, American Indian/Alaska Native, or, for underinsured children (ie, whose health insurance does not fully cover immunizations), when they are receiving services at a federally qualified health center or rural health clinic . Furthermore, the Patient Protection and Affordable Care Act of 2010 eliminated cost sharing in the form of copays, coinsurance, or deductibles for vaccines recommended by the ACIP . In addition to reducing financial barriers, studies have been done to better understand parental concerns about childhood immunizations and reasons for vaccine hesitancy, resulting in guidance for health care providers to enhance parental communication …”

Social Ecological Factors Associated with Parental Vaccination Decisions and Perceptions of Barriers to Childhood Immunizations

“…Children immunized according to the CDC-recommended schedule will have received a majority of the vaccines that protect against 14 different vaccine-preventable diseases before they reach two years of age. 21 Nationwide, school entry laws can only be enforced for this dynamic cohort if they attend a licensed CCF in a state that does not allow nonmedical exemptions. For nearly three decades the only two states not allowing NMEs (i.e., PBE or religious exemptions) to mandated school entry vaccines were Mississippi and West Virginia.…”

“…4,6 The discourse and research concerning childhood immunization practices suggest the complex nature of multiple factors influencing parental vaccination decisions and childhood immunization uptake. Factors cited in the literature, include, but are not limited to: parental barriers to childhood immunizations, [7][8][9] poor parental vaccine literacy or vaccination confidence (e.g., knowledge, attitudes, and perceptions about the safety and efficacy of vaccines); [10][11][12] missed, limited and/or untailored vaccine education; 13,14 vaccine education/information sources (e.g., health care provider, or sources with misinformation, such as Internet anti-vaccination websites); [15][16][17] parents' interactions with healthcare providers; 18-20 socioeconomic barriers; 21,22 and nonmedical exemptions (i.e., personal beliefs exemption [PBE] or religious exemption) to school vaccine mandates in states where they are permitted. 23,24 All of these factors must be considered together to better understand parental childhood immunization practices.…”