A national survey of state immunization program managers reveals gaps in coverage for the current vaccine financing system, suggesting that many underinsured children may not receive recommended vaccinations, such as for pneumonia and meningitis, according to a report in the August 8 issue of JAMA.
The number and cost of new vaccines routinely recommended for children and adolescents has increased considerably since 2003. New or expanded recommendations for meningococcal conjugate, tetanus-diphtheria-acellular pertussis (Tdap), hepatitis A, influenza, rotavirus, and human papillomavirus vaccines have led to 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), the authors write.
Childhood vaccines in the U.S. are financed by a patchwork of public and private sources. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (i.e., have private insurance that does not cover all recommended vaccines). In 2000, approximately 14 percent of children were underinsured for vaccines in the United States, requiring families to either pay out-of-pocket for the cost of vaccines not covered or forego receiving vaccines, according to background information in the article.
Grace M. Lee, M.D., M.P.H., of Harvard Medical School, Childrens Hospital Boston and Harvard Pilgrim Health Care, Boston, and colleagues examined the status of financing and distribution of new pediatric vaccines at the state level. For the 2-phase study, the researchers interviewed nine state immunization program managers and subsequently interviewed and surveyed 48 state immunization program managers from January to June 2006.
The researchers found that many states were not able to provide state-purchased vaccines for underinsured children in the private sector, public sector, or both. For example, fo
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