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High Costs May Reduce Access to Childhood Immunization

December 02, 2008 05:14 PM
by Emily Coakley
As public health officials worry about children skipping immunizations, new reports suggest that low reimbursement rates may prevent some doctors from giving shots.

Varying Reimbursement Rates

Some doctors who are losing money on childhood immunizations might stop giving the vaccinations, according to a survey published in the journal Pediatrics the Associated Press reported.

Another study showed a wide discrepancy on how much different doctors make or lose on the same vaccinations. One vaccine was a money-loser for one-tenth of the doctors surveyed, while other doctors made $40 on the same shot.

“It’s a pleasure to see a real study to show we’re not just making this up,” Dr. Herschel Lessin, a New York pediatrician, told AP.

Lessin said that his practice is spent twice as much on vaccines in 2007 over 2006. Despite that, he didn’t think many pediatricians would stop providing vaccinations, as it is part of their “core business,” but family doctors, who have a wider range of services to rely on for income, might decide to stop them.

The survey findings seem to bear that out. More than 20 percent of family doctors said they were thinking about dropping vaccinations, whereas just 5 percent of pediatricians are considering it, AP reported.

Finding a doctor to do immunizations is already a problem in some areas.

According to a report published in June by the group Immunize Kansas Kids, nearly half of the state’s counties lack a private provider who offers immunizations.

The cost of vaccinations is a problem for some Kansas doctors, too, according to the report: “Many providers who offer immunizations don’t fully recover their administrative costs. There are wide variations in the reimbursements paid by insurance carriers for administering immunizations.”

About half of the Kansas providers who did give immunizations weren’t using free shots provided by the program Vaccines for Children, the report said.

Though Lessin predicted fewer pediatricians would give up the vaccination business, a 2004 study in the journal Pediatrics that analyzed the costs involved with vaccinations showed that immunizations cost pediatricians 41 percent more than family doctors or public health clinics. While a difference in salaries between rural and urban practitioners in the study was a major factor, the research also found that another factor was who spent the time with the child. In pediatricians’ offices, doctors were more likely to administer the vaccinations, while in family practices and clinics, nurses, whose time cost less, gave immunizations.
But even in 2004 providers were seeing decreased reimbursement rates for physicians.  “The narrowing gap between average reimbursement and providers’ cost is cause for concern about whether private practices will be able to continue providing immunizations if their reimbursement relative to cost continues to decline,” the study said.

Background: Growing concerns over vaccination rates

The Pediatrics studies illustrate another challenge in public health officials’ goal to vaccinate as many children as possible.

Recently, more parents have chosen to forego childhood vaccinations because of autism concerns. Experts say any connection between autism and immunizations is unsubstantiated.

At the same time, outbreaks of once-rare diseases such as measles are being reported throughout the country. Measles had been largely eradicated from the United States, thanks to high vaccination rates.

Parents’ choices not to vaccinate sometimes also lead to social problems for their children, who are excluded from playgroups or classrooms.

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