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The utilization of pneumococcal polysaccharide vaccine among elderly Medicare beneficiaries, 1985 through 1988
A M McBean1, J D Babish, R Prihoda
1Division of Beneficiary Studies, Health Care Financing Administration, Baltimore, MD 21207.
Abstract:
Since July 1981, Medicare has paid for the administration of pneumococcal vaccine without regard to the deductible limit and without copayment. Claims submitted to Medicare for reimbursement for the 4-year period from 1985 through 1988 for a 5% sample of elderly Medicare beneficiaries enrolled in part B who were not members of health maintenance organizations were analyzed. Vaccine was administered to an estimated 1,392,840 beneficiaries (5.34%). The total estimated cost to Medicare was $14.3 million, or approximately $10.27 per dose. Crude 4-year rates indicated that white persons were much more likely to be immunized than black persons (5.60% vs 2.94%). Persons 70 through 84 years of age had higher immunization rates than either younger or older beneficiaries. The number of immunizations given peaked in 1986 and declined thereafter. A variety of vaccination strategies that may raise the immunization level in the elderly have been developed. The broad implementation of successful strategies will be important if the goal of a 60% immunization level in the elderly by the year 2000 is to be reached.
Insights
Medicare covered pneumococcal vaccine administration for over 1.3 million elderly beneficiaries from 1985-1988. Despite coverage, immunization rates remained low, especially among Black individuals, highlighting a need for improved vaccination strategies.
Area of Science:
- Public Health
- Gerontology
- Epidemiology
Background:
- Medicare has covered pneumococcal vaccine administration without deductibles or copayments since July 1981.
- Pneumococcal vaccination is crucial for preventing serious infections in the elderly population.
Purpose of the Study:
- To analyze Medicare reimbursement claims for pneumococcal vaccine administration to elderly beneficiaries from 1985 to 1988.
- To assess vaccination rates and identify demographic disparities among elderly Medicare beneficiaries.
Main Methods:
- Analysis of a 5% sample of Medicare Part B claims for beneficiaries not in health maintenance organizations (1985-1988).
- Calculation of estimated number of beneficiaries vaccinated, total cost, and vaccination rates by demographic factors.
Main Results:
- An estimated 1,392,840 beneficiaries (5.34%) received the vaccine, costing Medicare $14.3 million ($10.27 per dose).
- White beneficiaries (5.60%) had higher immunization rates than Black beneficiaries (2.94%).
- Beneficiaries aged 70-84 years showed higher vaccination rates; peak administration occurred in 1986, followed by a decline.
Conclusions:
- Despite Medicare coverage, pneumococcal vaccination rates among the elderly remained suboptimal during the study period.
- Significant racial disparities in vaccination rates were observed, indicating a need for targeted interventions.
- Achieving the year 2000 goal of 60% elderly immunization requires broad implementation of effective vaccination strategies.