Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Vaccine Financing From the Perspective of Primary Care Physicians
Sean T. O’Leary, MD, MPHa,b, Mandy A. Allison, MD, MSPHa,b, Megan C. Lindley, MPHc, Lori A. Crane, PhD, MPHa,d, Laura P. Hurley, MD, MPHa,e,f, Michaela Brtnikova, PhDa, Brenda L. Beaty, MSPHa,f, Christine I. Babbel, MSPHa, Andrea Jimenez-Zambrano, MPHa, Stephen Berman, MDb, and Allison Kempe, MD, MPHa,b,f
Author Affiliations
aChildren’s Outcomes Research, Children’s Hospital Colorado, Aurora, Colorado;
bDepartment of Pediatrics, and
fColorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
cNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
dDepartment of Community & Behavioral Health, Colorado School of Public Health, Denver, Colorado; and
eDivision of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado
http://pediatrics.aappublications.org/content/133/3/367.abstract

Abstract
OBJECTIVES: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available.

METHODS: A national survey among private pediatricians and family physicians April to September 2011.

RESULTS: Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children’s Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty.

CONCLUSIONS: Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.