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 That number is actually somewhat encouraging, said
coauthor Megan Lindley, from the Centers for Disease Control and
Prevention (CDC) in Atlanta.
"This echoes findings from a survey that CDC did four years earlier
in 2007," she said, and seeing that the 10 percent figure has not
gone up is a good sign.
"You never want to see that figure at all, but seeing that it is not
growing is encouraging," Lindley told Reuters Health.
If a pediatrician does decide to stop offering vaccines, parents
will have to take their children elsewhere to get shots. Lindley
stressed that the survey did not address whether doctors had
actually discontinued the vaccines, only if they had considered it.
Newer vaccines like Gardasil for human papillomavirus (HPV) tend to
cost doctors more up front than older vaccines. That's because
bringing new vaccines to the market takes expensive clinical trials
and researchers have already developed the "low hanging fruit"
vaccines, Lindley said.
As of 2012, complete vaccinations through age 18 for one child cost
about $2,500, the authors write. Vaccines are given during up to 35
separate appointments.
Private pediatric practices purchase these vaccines and are
reimbursed in two ways, once for the vaccine itself and once for
administration, by either private insurance or public insurance like
Medicaid. The amount doctors pay to buy vaccines and the amount they
are reimbursed can vary a great deal, the authors note.
They asked 190 pediatricians and 181 family doctors about their
satisfaction with insurance reimbursements for buying and
administering vaccines.
A quarter of doctors responded "don't know" to both questions and
were not included in the results.
Among the rest, many were dissatisfied with insurance payments for
buying and administering vaccines. They were equally dissatisfied
with how public and private insurers reimbursed the cost of vaccines
themselves, but were more dissatisfied with public insurers when it
came to covering vaccine administration.
For public programs Medicaid and the Children's Health Insurance
Program (CHIP), 21 percent and 18 percent of doctors, respectively,
said they were very dissatisfied with payments for administration.
On average, Medicaid pays doctors $9.45 for vaccine administration,
compared to $16.62 for private insurance companies. With private
insurers, doctors can negotiate higher reimbursements.
Doctors who were most dissatisfied with insurance payments were
often the same ones who had considered ending their vaccine
programs.
"The good news is that for parents, many of the problems related to
vaccine financing are being addressed by the Affordable Care Act,
which requires first dollar coverage - meaning no copay - for all
recommended vaccines for insured patients (in non-grandfathered
health plans, which is most of them)," lead author Dr. Sean O'Leary
told Reuters Health in an email.
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"The issue is if their child's doctor doesn't carry a particular
vaccine, it makes it that much harder to get their child fully
vaccinated," O'Leary, from Children's Hospital Colorado in Aurora,
said.
Parents with already busy schedules may end up having to make two
trips, one for the checkup and some of the vaccines and another
somewhere else to get the recommended vaccines their doctor didn't
carry, he said. Some parents might not make that second trip, or
might not have anywhere to go even if they wanted to, he said.
"The bacteria and viruses that cause vaccine-preventable diseases
are still ‘out there' in our society," Dr. David T. Tayloe, Jr.,
founder of Goldsboro Pediatrics in North Carolina, told Reuters
Health. "Therefore, unimmunized children will be at risk to contract
vaccine preventable diseases."
If 10 percent of providers say they are considering no longer
offering childhood vaccines, that is concerning, Dr. Walter A.
Orenstein, associate director of the Emory Vaccine Center in
Atlanta, told Reuters Health. Neither he nor Tayloe was involved in
the new study.
"A real question is whether the responses given in the survey, when
it was conducted in 2011 reflect the current views or whether those
views are better or worse today than at the time of the survey,"
Orenstein said.
Because the Affordable Care Act called for an increase in
Medicaid and CHIP vaccine reimbursement for at least 2013 and 2014,
doctors might feel a bit better now than they did in 2011, he said.
Some states purchase vaccines from manufacturers, essentially
providing them to doctors free of charge, but putting this system in
place in more states would be "politically challenging," O'Leary
said.
"Smaller scale fixes would be things like purchasing pools for
smaller practices so that they can negotiate the best price for
vaccines, and insurers working with practices and professional
organizations to provide timely and fair reimbursement for
vaccination," O'Leary said.
"Vaccination is incredibly valuable to our society - worth far more
than the present costs - and it would be great if everyone,
including insurers and policy makers, would start considering not
just the cost of vaccines in their decision-making, but their value
to society as well," he said.
SOURCE: http://bit.ly/1k4FhDR
Pediatrics, online February 24, 2014.
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