Tuesday, August 7, 2007

Underinsured children fall into vaccine gap

By Elizabeth Cooney, Globe Correspondent

Children whose private health insurance does not pay for new recommended vaccines may not be eligible to receive them in public programs, leaving them more vulnerable than if they had no insurance, according to a Harvard study.

These gaps are occurring as the number and cost of new vaccines have escalated. New vaccines recommended for children have doubled in the past five years and the cost to fully vaccinate a child -- about $1,170 -- is 7.5 times higher in 2007 than it was in 1995, Dr. Grace M. Lee of Harvard Medical School and colleagues write in tomorrow’s Journal of the American Medical Association. They surveyed state immunization program managers in 48 states from January to June 2006.

"We assumed kids with health insurance would have coverage for vaccinations, but we found a group of children whose insurance didn’t cover the cost of vaccine. That to me was surprising," Lee said in an interview.

Those children were referred to public health clinics, but they were still unable to receive vaccine because funding to pay for it was not available, the researchers found. The work was funded by the US Centers for Disease Control and Prevention.

"To us that was alarming because we had always seen the public sector as a safety net for vulnerable children," said Lee, also of Children’s Hospital Boston and Harvard Pilgrim Health Care. "Now we find that with the newer, more expensive vaccines, a lot of states are unable to provide these vaccines to kids who can’t afford them."

Massachusetts covers all children for all vaccines recommended by the Advisory Committee on Immunization Practices, except the new vaccine against human papillomavirus. ACIP sets policy for the federal Vaccines for Children program, which pays for all vaccinations for children who are uninsured, eligible for Medicaid, of American Indian or Alaskan Native origin, or seen at a federally qualified community health center.

In July, Massachusetts began providing rotavirus and meningococcal conjugate vaccines for all children, Dr. Susan M. Lett of the state Department of Public Health and a co-author of the JAMA article said in an interview. The vaccines to protect against severe diarrhea in infants and meningitis in teenagers, respectively, were included in the state budget recommended by Governor Deval Patrick. The governor's budget had also proposed coverage for a vaccine for adolescent girls against HPV, the virus that causes cervical cancer, but the legislature requested a study on it instead.

The JAMA study did not attempt to find out how many families might pay out of pocket for vaccines. The HPV vaccine costs about $120 for each of three doses, the meningitis vaccine costs about $80, and the rotavirus vaccine costs about $60.

"I imagine that if a family can’t afford health insurance that covers vaccines, they probably wouldn’t be able to afford to pay for that," Lee said.

Based on a 2000 estimate by other researchers that 14 percent of children in the United States are underinsured, the JAMA authors estimate that 2.3 million children are unable to receive meningococcal conjugate vaccine from their private health care providers and 1.2 million children can’t get it from public health clinics.

In an accompanying editorial, Dr. Matthew M. Davis of the University of Michigan suggests a tiered approach to financing newly recommended vaccines for underinsured children where funding is not available.

"Vaccines that benefit more of the population per individual immunized would receive higher priority," he writes.

Lee and her co-authors suggest working with insurance plans to include coverage.

"Until those enhancements can be made to health insurance plans, I think we need to support our public sector safety net," she said. "We need to come up with funding for these kids who are falling through the cracks to bridge the gap until we can have all health insurance plans covering vaccines."

Posted by Elizabeth Cooney at 07:07 PM

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