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Financial barriers to the adoption of combination vaccines by pediatricians
Courtney A Gidengil1, M Maya Dutta-Linn, Mark L Messonnier
1Children’s Hospital Boston, Boston, Massachusetts, USA. gidengil@rand.org
Insights
Financial barriers, including inadequate reimbursement, prevent many pediatricians from using combination vaccines. Practice size and public insurance rates also influence adoption of these important infant vaccines.
Area of Science:
- Pediatric Health
- Vaccinology
- Health Economics
Background:
- Combination vaccines offer advantages in pediatric immunization schedules.
- Understanding barriers to their adoption is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence of combination vaccine use in pediatric practices.
- To identify financial barriers and other factors affecting the adoption of infant combination vaccines.
Main Methods:
- A national survey of pediatricians was conducted.
- Data were collected on the use of specific infant combination vaccines (DTaP-HepB-IPV and DTaP-IPV/Hib).
- Factors analyzed included practice size, patient insurance, and state financing policies.
Main Results:
- 78% of surveyed pediatricians used at least one infant combination vaccine.
- Inadequate reimbursement for vaccine purchase (23%) and administration (20%) were key barriers.
- Smaller practices, those with fewer publicly insured patients, and less supportive state policies were less likely to adopt combination vaccines.
Conclusions:
- One-fifth of pediatricians cited reimbursement issues as a reason for not using combination vaccines.
- Practice characteristics and public funding significantly impact the uptake of combination vaccines.
Objectives:
To describe the prevalence of combination vaccine use and the associated financial barriers faced by pediatric practices, and to identify determinants of adoption of combination vaccines.
Design:
Mailed national survey.
Setting:
Pediatric practices during the period from August through October 2008.
Participants:
Pediatricians randomly selected from the American Medical Association Masterfile.
Main Outcome Measure:
Use of 1 of 2 infant combination vaccines (the diphtheria and tetanus toxoids and acellular pertussis, hepatitis B virus, and inactivated poliovirus [DTaP-HepB-IPV] vaccine or the DTaP, IPV, and Haemophilus influenzae type b [DTaP-IPV/Hib] vaccine).
Results:
We received 629 responses (response rate, 67%). Four hundred ninety-two pediatricians (78%) reported using 1 or both of the infant combination vaccines of interest (ie, the DTaP-HepB-IPV or DTaP-IPV/Hib vaccine). More than half of the respondents said their practice did not receive adequate reimbursement for the purchase and administration of vaccines in general. More than one-fifth reported not using 1 or more of the combination vaccines because of inadequate reimbursement for the cost of vaccine doses (23% of respondents) and/or vaccine administration (20% of respondents). The infant combination vaccines studied were less likely to be used by smaller practices, by those with a lower proportion of publicly insured patients, and by those with less inclusive state vaccine financing policies.
Conclusions:
One in 5 pediatricians reported that inadequate reimbursement prevented their using 1 or more combination vaccines. Practice size as well as the proportion of children whose vaccinations are paid for by public funds appear to be important determinants of the adoption of combination vaccines.
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