Child/Adolescent Health

Many underinsured U.S. children are not getting needed vaccines due to the current vaccine financing system

Newly recommended vaccines for children and adolescents have nearly doubled in the past 5 years. This boosted the cost to fully vaccinate a child in the public sector from $155 in 1995 to $1,170 in 2007. Childhood vaccines in the United States are financed by a patchwork of public and private sources.

This vaccine financing system has resulted in many underinsured U.S. children unable to receive publicly purchased vaccines in either private practices or public health clinics, according to a new study. In the past, private doctors have referred underinsured children to public health clinics for vaccination. However, a growing number of States are no longer able to provide expensive vaccines to children at these clinics.

Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population. For example, insurers and employers could be required or given incentives to enhance immunization benefits, suggests Grace M. Lee, M.D., M.P.H., of Harvard Medical School.

Dr. Lee and colleagues conducted a national survey of State immunization program managers in 2006. Only 34 percent of States had a health insurance mandate that required insurers to cover currently recommended vaccines for children and adolescents. Also, many States were not able to provide State-purchased vaccines for underinsured children in the private sector, public sector, or both.

As a result, underinsured children were not eligible to receive meningitis and pneumonia vaccines in the private sector in 70 percent and 50 percent of States, respectively, or in the public sector in 40 percent and 17 percent of States, respectively. Disparities among States were worse for the most expensive and newest vaccines, including pneumonia, meningitis, and hepatitis A.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13908).

See "Gaps in vaccine financing for underinsured children in the United States," by Dr. Lee, Jeanne M. Santoli, M.D., Claire Hannan, M.P.H., and others, in the August 8, 2007, Journal of the American Medical Association 298(6), pp. 638-643.

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