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Underinsurance and pediatric immunization delivery in the United States
Philip J Smith1, Noelle-Angelique Molinari, Lance E Rodewald
1Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA 30333, USA. pzs6@cdc.gov
Insights
Underinsured children receiving vaccines at health department clinics (HDCs) have lower timely vaccination rates for newer vaccines. Stable funding is needed for HDCs to cover costs of expensive vaccines for these vulnerable children.
Area of Science:
- Pediatric Health
- Immunization Policy
- Health Economics
Background:
- A significant portion of children are underinsured, with private insurance that doesn't cover vaccine costs.
- These children may not qualify for publicly funded vaccines through the Vaccines for Children (VFC) Program unless accessing specific clinics.
- Primary care providers may refer underinsured children to health department clinics (HDCs) for vaccinations, potentially impacting coverage rates for newer, costlier vaccines.
Purpose of the Study:
- To estimate the percentage of underinsured children in the U.S. who receive vaccinations at HDCs and are not VFC-entitled.
- To assess the association between being underinsured, receiving care at an HDC, and achieving timely vaccination coverage.
Main Methods:
- Analysis of data from 16,621 children aged 19-35 months from the 2007 National Immunization Survey.
- Comparison of vaccination coverage rates between underinsured children receiving care at HDCs and fully insured children.
Main Results:
- An estimated 10.5% of children aged 19-35 months were underinsured.
- Approximately 1.4% were underinsured, received doses at an HDC, and were not VFC-entitled.
- Underinsured children receiving care at HDCs showed significantly lower vaccination coverage for varicella and PCV7 vaccines compared to fully insured children.
Conclusions:
- Underinsured children receiving vaccinations at HDCs exhibit lower timely coverage for recently recommended and more expensive vaccines.
- Sustained and stable funding is crucial for HDCs to procure and administer new and costly vaccines to ensure adequate immunization for underinsured populations.
Background:
Underinsured children are covered by private health insurance that does not cover the cost of vaccines, are not entitled to receive publicly purchased vaccines at no cost through the Vaccines for Children (VFC) Program unless they receive doses at a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), may be referred by their primary care providers to health department clinics (HDCs) for vaccinations, and may have lower vaccination coverage for new and more expensive vaccines.
Objectives:
To describe the estimated percentage of children in the U.S. who are underinsured, receive vaccine doses at HDCs, and are not VFC-entitled; and to evaluate the association between being underinsured, receiving vaccine doses at an HDC, and timely vaccination coverage.
Methods:
Subjects were 16,621 19-35 month-old children sampled by the National Immunization Survey in 2007.
Results:
Of all 19-35 month-old children, an estimated 10.5% were underinsured; and an estimated 1.4% were underinsured, received doses at an HDC, and were not VFC-entitled. Compared to fully insured children, children who were underinsured and received doses at an HDC had significantly lower vaccination coverage for the varicella (81.5% vs. 87.7%, p < 0.05) and PCV7 (55.1% vs. 75.9%, p < 0.05) vaccines.
Conclusions:
Children who were underinsured and received doses at HDCs were found to have lower estimated timely vaccination coverage for recently recommended vaccines and more expensive varicella and PCV7 vaccines. To adequately vaccinate these children at HDCs, states require stable funding to pay for vaccines as the number of new and more expensive vaccines grows.
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