1 / 43

Out-of-Pocket Costs Associated with Childhood Immunizations

Out-of-Pocket Costs Associated with Childhood Immunizations. Noelle-Angelique Molinari, PhD Health Economist National Immunization Program, CDC. Collaborators. Rich Schieber, MD, MPH Mark Messonnier, PhD. Background. NIS Data: Georgia.

ganit
Download Presentation

Out-of-Pocket Costs Associated with Childhood Immunizations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Out-of-Pocket Costs Associated with Childhood Immunizations Noelle-Angelique Molinari, PhD Health Economist National Immunization Program, CDC

  2. Collaborators • Rich Schieber, MD, MPH • Mark Messonnier, PhD

  3. Background

  4. NIS Data: Georgia

  5. Strongly recommends reducing out-of-pocket (OOP) costs to increase vaccination rates Suggests this may be accomplished by: Providing free vaccine Reducing administration costs Providing insurance coverage Reducing copayments at POS Guide to Community Preventive Services

  6. Benefits of Lower OOP Costs • Increased coverage • Law of Demand • price decline leads to increased quantity demanded • 13 studies* show decrease OOP associated with increase coverage • Encourages medical home for all care • IZ more prompt & timely * Briss PA et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140

  7. Problems of Higher OOP Costs • Multiple IZ providers, esp. health depts. • Lower coverage rates • Push to seek care outside medical home • Disparity in OOP costs may directly result in disparity in coverage

  8. Purpose

  9. Purpose • To estimate OOP costs associated with childhood IZ: • Under current standards of care received at medical home • For a defined, large, heterogeneous population • To determine whether disparities exist by • Insurance status • Payer types

  10. Methods

  11. Assumptions: Optimal Care • Georgia 2003 birth cohort • No change in insurance distribution across age or over time • Full compliance with AAP 2003 vaccine schedule • Each child receives current standard of care in medical home • Each child receives shots as soon as eligible

  12. Assumptions: Optimal Care • 7 visits from birth through age 4 • Each private MD visit includes well-child exam, vaccine, and administration fee • No new combination vaccines used • No submitted charges are disallowed by insurance • No shortages • Relative prices remain constant over time

  13. Universe of Potential Payers, Georgia, 2003

  14. Data Sources

  15. Total Cost per Visit Total Cost = (WC Exam Fee) + (Vax Fee) + (# Vax) (Vax Admin Fee) • WC Exam = Well-child exam fee • Vax Fee = Vaccine price to patient • # Vax = No. of vaccines given that visit • Vax Admin Fee = Fee charged for administering shot

  16. Out-of-Pocket (OOP) Cost per Visit OOP = Copay(WC Exam)+ Copay(Vax) + Copay(Vax Admin)(#Vax) • Copayment is the amt. of total charges a patient pays • Copay can be either: • Flat fee ($10) • Rate (10%)

  17. Example: Private Insurance6 mo old HepB, DTaP, Hib, IPV, PCV

  18. Example: VFC, Private MD6 mo old HepB, DTaP, Hib, IPV, PCV

  19. Example: VFC, Health Dept6 mo old HepB, DTaP, Hib, IPV, PCV

  20. Per-Child Cost • Sum all costs over 7 visits • Discount to obtain present value of per-child cost in 2003 dollars

  21. Cost for Georgia 2003 Cohort • Multiply • OOP cost-per-child for each insurance category • # children in that insurance category (CPS 2004 data) • Result is population-weighted estimate of OOP costs associated with childhood immunization for Georgia’s 2003 birth cohort

  22. Results

  23. Total Costs per Child by Insurance Type Birth through Age 4

  24. OOP Costs per Child by Insurance Type Birth through Age 4

  25. Costs Associated with Immunization 2003 Georgia Birth CohortUninsured Go to Private MD

  26. Costs Associated with Immunization 2003 Georgia Birth CohortUninsured Go to Health Dept

  27. OOP Costs & IZ Coverage • Coverage negatively correlated with OOP costs * Phil Smith provided information from NIS 2003 on GA IZ coverage rates by plan type.

  28. Limitations

  29. Data are Not Perfect • HIP Enrollment survey 61% response (enrollment per plan) • Tricare weights are estimated, not based on enrollment • Copayments are based on benefit plan descriptions rather than actual reimbursements (except Large group)

  30. PossibleImplications

  31. Implications… • Decreasing OOP costs will increase coverage • Plan designs are skewed toward low OOP costs • VFC reduces OOP cost & thereby reduces insurance-based disparities • Uninsured still face high OOP costs • Medicaid & SCHIP low OOP cost encourages IZ among low income children

  32. Policy Implications • Are child vaccinations (not just vaccines)based on an entitlement or a discount program? • How might IZ coverage change with decreased availability of public health clinics? • Funding is not keeping pace with Medicaid/ SCHIP expansion. How will this affect IZ coverage?

  33. Thank you

  34. Appendix

  35. Payments & Copays by Visit • Individual & Small Group

  36. Payments & Copays by Visit • Large Group

  37. Payments & Copays by Visit • Tricare

  38. Payments & Copays by Visit • Medicaid & Peachcare

  39. Payments & Copays by Visit • Medicare & Uninsured

  40. Cost per Child • Calculated present value of 7 visits using 3% discount rate with monthly basis • r = 3%, m = 12 • Burden in today’s dollars of childhood vaccinations from birth through age 4

  41. Total & OOP Costs per visit by Insurance type in Georgia, 2003

  42. Discounted Total & OOP Costs per Child by Insurance type in Georgia, 2003

  43. ACIP 2003 Schedule

More Related