Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Coleman, Margaret S.; Lindley, Megan C.; Ekong, John; Rodewald, Lance

doi:10.1542/peds.2009-1542g

Cited by 38 publications

(30 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several recent studies of private pediatricians documented the potential for financial losses, from both vaccine purchase and vaccine administration, associated with providing vaccines to children and adolescents. [41][42][43][44] Concerns about reimbursement for vaccine purchase may be increasing as more-expensive vaccines are recommended for routine use. Two recent studies showed significant variation in both the prices private pediatric practices pay for identical vaccines and the insurance reimbursements they receive.…”

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

“…Two recent studies showed significant variation in both the prices private pediatric practices pay for identical vaccines and the insurance reimbursements they receive. 41,42 Some practices are reimbursed more than the costs of the vaccines themselves, whereas others receive reimbursement that is less than they pay for vaccines; in 1 study, 21% of practices received less in reimbursement than their actual costs for purchasing a dose of varicella vaccine. 41 Some of the variability in vaccine purchase prices and reimbursements is likely attributable to suboptimal business practices in provider offices.…”

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

“…In 1 study, practices broke even or made small profits from vaccinating privately insured children, on average, but were undercompensated for vaccinating VFCeligible children. 42 In general, private insurers reimburse more for vaccine administration than Medicaid reimburses for VFC vaccine administration. [42][43][44] However, even private insurance reimbursements vary widely and do not always cover a provider's cost to administer vaccines.…”

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

“…[42][43][44] However, even private insurance reimbursements vary widely and do not always cover a provider's cost to administer vaccines. 42,43 Providing vaccination services to both privately and publicly insured children and adolescents may be financially unsustainable for some practices, particularly if they serve larger proportions of VFCeligible patients.…”

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2009

Self Cite

View full text Add to dashboard Cite

Recent increases in the number and costs of vaccines routinely recommended for children and adolescents have raised concerns about the ability of the current vaccine financing and delivery systems to maintain access to recommended vaccines without financial barriers. Here we review the current state of US financing for vaccine delivery to children and adolescents and identify challenges that should be addressed to ensure future access to routinely recommended vaccines without financial barriers. Challenges were considered from the perspectives of vaccine providers; state and local governments; insurers, employers, and other health care purchasers; vaccine manufacturers; and consumers. Pediatrics 2009;124:S548-S557

show abstract

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

Section: Pressure On Private-sector Providersmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…41,42 Practices typically break even or gain small profits from vaccinations billed to commercial payers, whereas the opposite is true for those billed to Medicaid. 43 Because the modeled practice is a 50/50 payer mix, vaccines are excluded from both the FFS and capitation models.…”

Section: Expense and Revenues Under Ffs And Capitationmentioning

confidence: 99%

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice

et al. 2016

View full text Add to dashboard Cite

show abstract

Vaccine Marketing

Angelmar¹,

Morgon²

2013

International Series in Quantitative Marketing

View full text Add to dashboard Cite

Long perceived as an unattractive segment of the pharmaceutical industry, most of the leading fi rms have stepped up vaccine investments in recent years. Unlike mainstream pharmaceuticals, vaccines generally treat healthy individuals, most are administered only once or very infrequently during a life time, and they engender positive externalities, because vaccinated individuals reduce the risk of transmission to unvaccinated persons, leading authorities to mandate some vaccinations. Resistance to vaccination may lead to immunization failure and disease resurgence.The public and private market each account for about one-half of the global vaccine market in value. Bringing new vaccines to market requires carefully orchestrated programs targeting the multiple types of customers. For example, in parallel with the clinical development program designed to obtain FDA approval for its HPV vaccine Gardasil, Merck developed health-economic evidence to obtain a positive recommendation for vaccination and public fi nancing. Physician educational programs and unbranded DTC campaigns were started many months prior to launch. Following FDA approval and positive vaccination and public fi nancing recommendations, Merck developed market access programs targeted at states and private insurers, and launched branded physician and DTC campaigns.Successful global diffusion of a vaccine generally requires the development of a tiered pricing policy which takes country differences in per capita income into account.A successful launch often creates new problems for vaccine marketers. They must maintain the motivation to engage in and pay for vaccination despite the quasi-disappearance of the disease. And they must combat anti-vaccination information claiming that the vaccine is the cause of serious side effects.

show abstract

Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Abstract: We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.

Cited by 38 publications

References 16 publications

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

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

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice

Vaccine Marketing

Contact Info

Product

Resources

About