Many Kids With Private Insurance Missing Vaccinations

TUESDAY Aug. 7, 2007 -- Thanks to an increasingly complex coverage system, many U.S. kids who are privately insured are actually having more trouble getting recommended vaccines than kids who have no insurance at all, experts say.

Gaps in coverage for an expanding repertoire of recommended shots are leaving many "underinsured" kids falling through the cracks, they said. Filling those gaps could remedy the situation, however.

"Until we can ensure that such enhancements are made, we need to be able to support the public sector safety net so these children have some place to go, because right now, they have nowhere to go," said lead researcher Dr. Grace M. Lee, assistant professor of ambulatory care and prevention and pediatrics at Harvard Medical School, Children's Hospital Boston and Harvard Pilgrim Health Care.

"Our study highlights the need to enhance immunization benefits among insured children, making sure the appropriate requirements or incentives for employers and insurers are in place to make sure vaccines are covered," said Lee, whose team published its findings in the Aug. 8 issue of the Journal of the American Medical Association.

"Vaccines are our strongest prevention tool, and they're not being utilized as well as they could be," added Dr. Ciro Sumaya, founding dean of the Texas A&M Health Science Center School of Rural Public Health. "This has implications for the individual as well as for the population as a whole," said Sumaya, who is also a member of the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).

The problems reflect an impossibly complex system for patients, parents, practitioners, payers and policy makers, the experts said.

For one thing, the number of new vaccines recommended for children and adolescents has almost doubled over the past five years.

Then, there's the cost. "The HPV vaccine alone is $150 a dose at three doses," Lee said. "In the past, it was less than $100 to give all the vaccines" a child needed, Lee added.

The new or expanded recommendations for meningococcal conjugate, tetanus-diphtheria-acellular pertussis (Tdap), hepatitis A, influenza, rotavirus, and human papillomavirus vaccines (HPV) have resulted in a 7.5-fold increase in the cost to fully vaccinate a child in the public sector -- from $155 in 1995 to $1,170 in 2007.

"As one learns more about vaccines, there are more complexities in the timing, the age levels, can you give it with other vaccines," Sumaya said. "Thirty years ago, all the vaccine recommendations were on one sheet of paper. Now, it takes several sheets of paper, with a lot of individual notes and exceptions."

Children who are uninsured, Medicaid-eligible or of American Indian/Alaska Native origin can get all the vaccinations recommended by the ACIP through the federal Vaccines for Children (VFC) program.

On the other hand, children with private health insurance often have plans that don't cover all the recommended vaccines, or the vaccine may be covered but not its administration.

In 2000, an estimated 14 percent of children aged 0 to 17 were underinsured in the United States, according to background information in the study. These children may be referred to public health clinics, but now, it seems, those clinics are no longer able to provide the needed vaccines.

"We had been hearing reports from state policy makers and clinicians about a lack of adequate funding to give vaccines to all children who needed them," Lee explained.

In the 2006 study, her group interviewed the program managers for state immunization programs in 48 states.

For vaccines given in the private sector, 46 percent of states did not provide publicly purchased chicken pox vaccine, and 70 percent did not provide publicly purchased meningococcal conjugate vaccine to underinsured children.

For vaccines given in the public sector, 17 percent of states were unable to provide publicly purchased pneumococcal conjugate vaccine, and 40 percent were unable to provide publicly purchased meningococcal conjugate vaccine to underinsured children.

Pneumococcal conjugate and meningococcal vaccines are among the newest vaccines, which tended to exhibit more disparities in delivery.

Due to limited financing for new vaccines, 10 states restricted access to publicly purchased new vaccines for underinsured children between 2004 and early 2006.

If 14 percent of children are assumed to be uninsured in the United States, then an estimated 2.3 million children aren't able to receive state-purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children are unable to receive the vaccine in the public sector, the researchers said.

The problem is only likely to get worse, experts said, as the proportion of children with inadequate insurance policies grows.

"We had assumed that all children with health insurance had access to vaccines, but this group didn't have access," Lee said. "This is really concerning, because we see public health clinics as safety nets for vulnerable children. But program managers are forced to turn away underinsured kids, and this is creating ethical dilemmas."

"We need to be able to find or increase sources of funding for vaccine purchase for underinsured kids," she continued.

More information

There's more on childhood immunization at Every Child By Two.

Posted: August 2007


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