Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
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Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis
Original Research Article
Pages 5724-5735
Juan Yang, Katherine E. Atkins, Luzhao Feng, Mingfan Pang, Yaming Zheng, Xinxin Liu, Benjamin J. Cowling, Hongjie Yu
Abstract
Background
To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national “free-at-the-point-of-care” vaccination program for priority populations recommended by the World Health Organization.
Methods
In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures.
Results
Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5–2.2% between 2004 and 2014. A free national vaccination program for priority populations (n = 416 million), would cost government US$ 757 million (95% CI 726–789) annually (uptake rate = 20%).
Conclusions
An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage.