Financing Vaccines in the 21st Century Assuring Access and Availability (2004) / Chapter Skim
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4 Delivery Systems
4 Delivery Systems
Pages 91-106
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From page 91... ...
The final section addresses barriers to achieving a well-functioning immunization delivery system. DELIVERY OF ADULT AND CHILDHOOD VACCINES Privately insured adult patients receive immunizations through private providers or frequently, in the case of influenza vaccine, at work or other non-medical sites.
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From page 92... ...
program, private providers generally immunized privately insured individuals, and public clinics immunized safety net populations. As discussed earlier, one of the goals of the VFC program was to increase the proportion of children who receive vaccines in their medical home.
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From page 93... ...
Community health centers, including federally qualified health centers (FQHCs) ,~ are fiscally stressed; and their capacity to serve their client base including their capacity to provide immunizations has been threatened in recent years (IOM, 2002d)
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From page 94... ...
For example, Michigan officials, responding to increased referrals from private providers experiencing vaccine shortages, directed local health departments to cease providing immunizations to underinsured children (Wendland-Bowyer and Askari, 2002~. While the public delivery system may be far from the breaking point, it is clearly under stress; and even gradual erosion of the system could lead to gaps in immunization.
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From page 95... ...
The AAP has received reports from pediatricians who owe significant amounts of money for pneumococcal conjugate vaccines that they purchased anticipating eventual third-party reimbursement (Fairbrother and Haidery, 2002~. Many found that the reimbursement they received did not adequately cover the price of the vaccine or that third-party payors were not providing reimbursement at all.
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From page 96... ...
Managing Inventories In states without universal purchase programs, private providers who participate in VFC must maintain two separate stocks of vaccines for their patients one for children eligible for state-purchased vaccines and one for those patients for whom they purchase vaccines in the private marketplace. Shortages or budgetary delays may deplete the public or private stocks of vaccine.
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From page 97... ...
. Administering Vaccines The additional work involved in administering a vaccine during a routine patient visit has been documented through time and motion studies (Fontanesi et al., 2001; LeBaron et al., 1999~.
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From page 98... ...
. Provider fees for uninsured ndividuals are paid through state public health funds, possibly supported fly Section 317 or federal block grant funding.
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From page 99... ...
The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) conducted a survey as part of their Adult Immunization Initiative and found that 85 percent of general internal medicine physicians believe reimbursement for immunization is inadequate and is a barrier to their practice's ability to provide immunization services (American College of Physicians-American Society of Internal Medicine [ACP-ASIM]
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From page 100... ...
BARRIERS TO A WELL-FUNCTIONING IMMUNIZATION DELIVERY SYSTEM Three principal barriers to a well-functioning immunization delivery system can be identified: excessive provider burden, inadequate and uncertain provider reimbursement, and high rates of referral to public clinics among private physicians. Each of these barriers is reviewed below.
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From page 101... ...
The referral of large numbers of patients even those who have private health insurance benefits for immunizations from private providers to public health clinics indicates problems with the public-private system. Before VFC, many providers routinely referred patients to public clinics for immunizations rather than risk uncertain payment.
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From page 103... ...
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From page 104... ...
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From page 105... ...
· Private providers refer patients to the public sector in large numbers in response to inadequate reimbursement and excessive administrative burdens. · Public clinics may provide insufficient access and capacity to maintain a reliable safety net for children and adults who are uninsured for immunization or referred from the private sector for other reasons.
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