Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1148-e1156 (doi:10.1542/peds.2006-3654)
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ARTICLE

Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan

Noëlle-Angélique M. Molinari, PhD, Maureen Kolasa, RN, MPH, Mark L. Messonnier, PhD and Richard A. Schieber, MD, MPH

Immunization Service Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

BACKGROUND. The "Guide to Community Preventive Services" strongly recommends reducing out-of-pocket costs to increase vaccination rates among children. Nevertheless, out-of-pocket expenses are still incurred during the receipt of childhood vaccines, vaccine administration, and associated well-child visits.

OBJECTIVE. Our goal was to estimate total and out-of-pocket costs of childhood immunization.

METHODS. We used the 2003 benefit-plan data for all 1217 private and public health plans registered in Georgia and the 2003 Advisory Committee on Immunization Practices recommended vaccine schedule to calculate costs to vaccinate children aged 0 to 5 years in 2003 dollars. By applying published estimates of health insurance enrollment of Georgia children, we calculated the total and out-of-pocket costs per child according to insurance status and race/ethnicity. Immunization coverage according to payer type was based on National Immunization Survey data.

RESULTS. Out-of-pocket costs ranged between $0 (Medicaid/Peachcare) and $652 (uninsured/Medicare). Most out-of-pocket costs were incurred during the first year of life. Up-to-date immunization status ranged from 63.7% for uninsured persons to 83.2% for privately insured persons. Up-to-date status was negatively correlated with out-of-pocket costs and the proportion of the population below 250% of the federal poverty level.

CONCLUSIONS. For most Georgia families, out-of-pocket expenses for childhood immunizations were low, favoring compliance with the recommended immunization schedule. However, families least able to afford the expense faced disproportionately high out-of-pocket costs. Out-of-pocket costs were inversely correlated with immunization coverage levels. Uninsured children whose families lived below 250% of the federal poverty level experienced the lowest immunization coverage levels. Immunization coverage through the Vaccines for Children Program and Medicaid/State Children's Health Insurance Programs should be promoted to minimize or eliminate out-of-pocket costs related to childhood immunizations, especially among children of low-income families.

Key Words: immunization • out-of-pocket costs • insurance

Abbreviations: OOP—out-of-pocket • CI—confidence interval • VFC—Vaccines for Children • UTD—up-to-date • CPS—Current Population Survey • SCHIP—State Children's Health Insurance Program • CDC—Centers for Disease Control and Prevention • FPL—federal poverty level • 4:3:1:3:3—≥4 doses of diphtheria, tetanus, and acellular pertussis vaccines, ≥3 doses of poliovirus vaccine, ≥1 dose of measles, mumps, and rubella vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine

Accepted Apr 12, 2007.


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