Financing Vaccines in the 21st Century Assuring Access and Availability (2004) / Chapter Skim
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3 Public and Private Insurance Coverage
3 Public and Private Insurance Coverage
Pages 63-90
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From page 63... ...
Adults aged 18-64 are covered less frequently for immunizations than either children or the elderly (see Figure 3-2~. Private insurance covers about 41 percent of this population for immunizations, and public programs cover about 9 percent.
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From page 64... ...
517 0.7 Uninsured 8,406 10.9 Subtotal 77,201 100.0 Adolescents and Adults 18-64 Medicaid-enrolled 10,582 6.0 Private insured immunization covered 72,050 40.9 Underinsured for immunization not high risk 38,270 21.7 Underinsured for immunization high risk 20,680 11.7 Medicare-enrolled (disabled-ESRDa) 4,778 2.7 Uninsured not high risk 21,805 12.3 Uninsured high risk 8,229 4.7 Subtotal 176,394 100.0 Adults Aged 65+ Medicaid-enrolled 3,293 5.9 Private insured 20,761 30.6 Medicare-enrolled 31,733 57.0 Uninsured 245 0.4 Subtotal 56,032 100.0 aEnd-stage renal disease.
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From page 65... ...
Underinsured 33 4°/n Private Insurance 40.9% Public Coverage 8.7% Uninsured 17.0% FIGURE 3-2 Insurance coverage of vaccination, adults aged 18-64 (2000~.
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From page 66... ...
PUBLIC INSURANCE COVERAGE Funding for both vaccine purchase and immunization infrastructure has historically been shared by the federal government and the states (see Chapter 2~. While expenditures on vaccine purchase are increasingly determined by entitlement programs such as VFC and Medicaid, expenditures on infrastructure are largely discretionary and vary considerably from state to state.
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From page 67... ...
States purchase vaccines and either stockpile them for distribution to registered providers or make arrangements with the manufacturer to deliver the vaccine directly to providers. By providing free vaccines to private providers for administration to VFC-eligible children in their medical homes, VFC has resulted in a large shift of public immunization from the public to the private delivery system (IOM, 2000a)
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From page 68... ...
This level was subsequently approved by Congress and included in the fiscal year 2001 and 2002 federal budgets.3 State and County Programs States and counties provide safety net coverage for immunization through public clinics and a variety of targeted outreach programs. These programs are funded by a variety of sources state general funds, federal maternal and child health block grants to the states, public health service block grants, federal programmatic grants, private foundations, and federal Section 317 grants.
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From page 69... ...
In addition, state funds are used to purchase vaccines for underinsured children in the offices of private providers. There are currently 15 states with enhanced-VFC programs, while 14 states have universal purchase programs in which ACIP-recommended vaccines are made available to all children, regardless of insurance status (see Table 3-3~.
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From page 70... ...
The last three columns of Table 3-4 indicate enrollment trends for each type of insurance plan. Given the more limited range of immunization benefits within PPOs relative to HMOs and point-of-service plans, immunization rates are likely to decline should these trends continue, if only because of the change in the relative market share of insurance plan types.
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From page 71... ...
SOURCES: Wood, 2003; KFF-HRET, 2002. The rates of private insurance coverage indicated in Figures 3-1 and 3-2 somewhat overstate the level of private coverage as a source of payment for immunization because they omit patient cost sharing in the form of deductibles and copayments.
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From page 72... ...
, 2003~. State laws, however, apply only to state-regulated plans; self-funded employer health plans, which represent about half of enrollees in private insurance plans,5 are exempt from state regulation under the Employee Retirement and Income Security Act (ERISA)
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From page 73... ...
These barriers gaps in coverage and patient cost sharing, funding delays, fragmentation, and a crowding out of private insurance are discussed below. Other barriers include socioeconomic status, education, public awareness, and administrative barriers (Santoli et al., 1998; Szilagyi and Rodewald, 1996~.
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From page 74... ...
It is therefore reasonable to ask how much of a difference coverage and cost sharing really make in immunization rates today. If they have a significant effect, public policies to increase coverage or reduce out-of-pocket costs would clearly be warranted; otherwise they would not.
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From page 75... ...
Freed, however, did not control for other variables that might have affected immunization rates over this period. · Recent data from CDC's National Immunization Survey suggest that, at least for expensive vaccines such as varicella, there is a substantial (12 percentage point)
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From page 79... ...
79 Do to ON 00 ~ u At)
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From page 80... ...
While these studies are unsatisfying in many respects, taken together they suggest that insurance and cost factors do influence immunization rates. This is the case especially for lower-income children without other insurance and for adults who lack compulsory immunization through state school entry requirements.
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From page 81... ...
Even public clinics must worry about eligibility. For example, VFC vaccines can be used for underinsured children, but only in FQHCs.
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From page 82... ...
For example, a study of privately insured children of parents working in a large corporation revealed that only 65 percent of the children were up to date with the 4:3:1 series at age 2 (Fielding et al., 1994~. Noneconomic factors that influence immunization rates include both personal and systemic variables (Bates and Wolinsky, 1998~.
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From page 83... ...
As noted earlier, the provision of vaccinations in the medical home is a hallmark of the VFC program. The implementation of VFC, as well as similar state-level universal purchase programs, coincided with substantial increases in immunization rates, suggesting that the medical home may make an important difference in the rates achieved (Freed et al., 1999; Nace et al., 1999~.
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From page 84... ...
While there is no direct evidence of reduced immunization rates or increased disease incidence as a result of recent vaccine shortages, there is some indirect evidence that a supply disruption may adversely affect provider immunization practices (Oram et al., 2001~. For example, CDC has reported that 52 percent of states suspended school immunization requirements as a result of the tetanus vaccine shortage (Orenstein, 2002c)
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From page 85... ...
There is, however, no direct evidence on the impact of combination vaccines on immunization rates. There are also potential drawbacks, including the presence of competing combinations with various overlapping antigen menus and subtle immunologic differences that may create confusion and/or administrative burden for busy practitioners (Le.
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From page 86... ...
estimates that 21 percent of privately insured children aged 0-5 have private insurance that excludes immunization. This suggests that 3.5 million chil
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From page 87... ...
Like children, adults face the problem of underinsurance. According to the Partnership for Prevention survey cited above, 59 million adults aged 18-64 have private insurance that does not include immunization benefits (Wood, 2003~.
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From page 88... ...
Fortunately, many adults have access to influenza immunization sponsored by employers, retail stores, and shopping malls. This may partly explain the significant gain in immunization rates among this population in the last several years.
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From page 89... ...
FINDINGS · An estimated 13.8 percent of children between birth and 5 years of age are underinsured (that is, have private insurance that does not include immunization benefits)
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