By American Public Health Association
Far too many U.S. children and adults are going without vaccinations because their health insurance does not fully cover the immunizations they need, according to a recent report from the Institute of Medicine.
To address the problem, the report recommends that the nation’s private and public health plans be required by law to provide insurance coverage for child and adult vaccinations, and that the government reimburse insurers for the costs associated with such vaccinations. The report also calls for the federal government to provide vouchers so that uninsured children and adults can receive vaccinations from the providers of their choice.
If enacted, the changes would transition the U.S. vaccine system from one that buys vaccine supplies to one that ensures immunizations are administered, according to the report.
“Immunizations against common, dangerous diseases convey valuable health and societal benefits, but the higher price of newly developed vaccines and the outmoded system by which they are financed create significant financial burdens on health plans, consumers, health providers and vaccine makers,” said Frank Sloan, PhD, a Duke University economics professor and chair of the IoM committee that authored the report.
The United States has had a long involvement in financing vaccines, purchasing bulk supplies of polio and measles vaccines in the 1960s. In 1993, Congress created the Vaccines for Children program, which guarantees federally purchased vaccines to more than 10 million U.S. children. Government purchases of vaccines, costing $1 billion a year, account for more than half of U.S. vaccine sales.
While U.S. childhood immunization levels are currently at an all-time high, wide variations exist among states and urban areas, according to the Centers for Disease Control and Prevention, which requested the IoM report. Recent vaccine shortages have further focused the spotlight on the vulnerabilities of the vaccine system.
The report, “Financing Vaccines in the 21st Century: Assuring Access and Availability,” noted that 16 percent of children who are covered by private health insurance are in plans that exclude benefits for immunizations. Because such children are not officially uninsured, they don’t qualify for government-sponsored vaccine programs and therefore may be more likely not to receive immunizations.
State policies that require students to receive vaccinations before beginning school help ensure that children get immunizations, but vaccination requirements vary widely from state to state. In 2002, a CDC survey of school nurses in the District of Columbia found that 50 percent of students needed one or more vaccinations to meet school requirements.
About 105 million adults ages 18 to 64 who have private insurance are in plans that don’t cover immunizations. Combined with the 30 million adults younger than age 65 who are estimated to be uninsured, 75 percent of adults in that age group lack immunization coverage, the report concluded.
Although older adults require fewer vaccines than children, recommendations call for them to be vaccinated against high-risk diseases such as pneumonia, influenza and hepatitis. Most of the 36,000 Americans who die of the flu annually are older adults.
The amount of immunization coverage an American receives under her or his health insurance plan often varies by their type plan type, the report found. While health maintenance organizations frequently cover immunizations as a basic benefit, preferred provider organizations often have more limited immunization benefits.
The number of Americans who are covered by preferred provider organizations has increased in recent years, representing 52 percent of employer-based enrollment, meaning that more people may face barriers to immunization.
The high price of new vaccines also presents a roadblock to expanding immunization coverage, the report found. About 20 doses of vaccines targeting 11 diseases are recommended for U.S. children, costing the public sector about $400 and the private sector about $600.
When newer, more expensive vaccines such as pneumococcal conjugate which provides protection against many serious infections were added to the recommended list of child vaccines in recent years, expenditures for the Vaccines for Children program jumped, increasing from $500 million in 2000 to $1 billion in 2002. As new vaccines are developed, licensed and produced, continued cost increases will occur, the committee predicted.
While vaccines provide a savings in health care costs in the long run by preventing disease, health agencies have to shoulder the short-term costs of buying and delivering vaccines, the report noted.
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