By Kathryn Doyle
NEW YORK (Reuters Heath) - Ten percent of pediatricians say they have seriously considered no longer providing vaccines due to concerns about their cost, according to results from a 2011 survey.
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.
"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.