Underinsured children in the U.S. increasingly at risk for not getting needed vaccines

Due to limited federal and state funding for vaccines, underinsured children in the United States are increasingly at risk for not getting needed vaccines, according to a new study published August 8 in the Journal of the American Medical Association.

FINDINGS:
Underinsured children, that is, those whose health insurance plans do not cover the cost of vaccines, often do not have access to all recommended vaccines.

RELEVANCE:
As of 2000, approximately 14 percent of children in the U.S. were underinsured. Since then, the cost of fully vaccinating a child has risen dramatically.

CITATION:
The Journal of the American Medical Association , Vol. 298 No. 6, August 8, 2007

The study, led by Harvard Medical School and Children's Hospital Boston Assistant Professor Grace Lee, found that many underinsured children are unable to receive publicly purchased vaccines in either the private or public sector. The authors state, “The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines.”

“Childhood immunization is ranked as one of the most important preventive health services we can offer,” says Dr. Lee, who is a member of the Department of Ambulatory Care and Prevention at the medical school and Harvard Pilgrim Health Care. “Due to the increased cost of recently recommended vaccines and the lack of available funding, many states have been forced to adopt more restrictive policies for the provision of publicly purchased vaccines. Underinsured children, who used to be able to rely on public health clinics as a safety net in the past, are now at risk of not getting immunized for serious childhood illnesses.”

Childhood vaccines are funded by a patchwork of public and private sources. While some private health insurance plans cover recommended vaccines for children, an increasing number of plans require patients to pay out of pocket for many of these vaccines. However, children who are either uninsured or publicly insured through Medicaid can receive vaccines through the federal entitlement program Vaccines for Children Program (VFC).

Declines in funding coupled with increases in the number and cost of vaccines has put underinsured children at risk for not receiving important vaccines. For example, in one part of this two-phased study, immunization program managers from 48 U.S. states were interviewed. The researchers found that in the private sector, 30 states were unable to provide meningococcal conjugate vaccine to underinsured children, and 24 states could not provide pneumococcal conjugate vaccine. In the public sector, those numbers were 17 and 8, respectively.

Put another way, roughly 2.3 million U.S. children could not receive publicly purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children could not receive this vaccine even if they were referred to public sector clinics.

“Studies suggest that many private clinicians refer underinsured children to public health clinics for vaccination,” says Tracy Lieu, MD, senior author on the study and also a professor at the Department of Ambulatory Care and Prevention. “Unfortunately, a growing number of states no longer provide the most expensive vaccines to these children. The problem may become worse since the trend in private health insurance is to shift to higher deductible plans and in many cases vaccines may not be covered unless the deductible is reached. This could put children from economically vulnerable families at risk of not getting vaccinated.”

According to Dr. Lee, many survey participants voiced concern about their inability to provide immunizations to underinsured children. In fact, since 2004, 10 states have revised their policies in order to restrict underinsured children's access to select new vaccines.

Lee warns that the situation is creating significant ethical dilemmas for public health clinicians who are being forced to turn these children away or ask families to pay for needed vaccinations.

“Despite the ability of vaccines to prevent illness and death, our current public safety net for these services is under considerable strain,” says Lee. “Strategies are needed to enhance immunization benefits for underinsured children in private health plans and to support the public sector safety net in order to ensure the protection of this vulnerable group of children.”

This study was funded by the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.

Written by Ann Plasso

Full citation:

The Journal of the American Medical Association , Vol. 298 No. 6, August 8, 2007

“Emerging Gaps in Vaccine Financing for Underinsured Children in the U.S.”

Grace M. Lee, MD MPH(1,2), Jeanne M. Santoli, MD(3), Claire Hannan, MPH(4), Mark L. Messonier, PhD(3), James E. Sabin, MD(1), Donna Rusinak(1), Charlene Gay(1), Susan M. Lett, MD MPH(5), and Tracy A. Lieu, MD MPH1,(6)

1-Department of Ambulatory Care and Prevention, Harvard Medical School & Harvard Pilgrim Health Care
2-Division of Infectious Diseases, Children's Hospital Boston
3-National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
4-Association of Immunization Managers
5-Massachusetts Department of Public Health
6-Division of General Pediatrics, Children's Hospital Boston

Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, VA Boston Healthcare System. For more information visit http://hms.harvard.edu

Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: http://www.childrenshospital.org/newsroom.