BACKGROUND:
In the US one-quarter of children ages 19-35 months of age are not fully vaccinated. Inadequate insurance coverage contributes to low immunization rates. Inadequate insurance coverage includes lack of any insurance, or having private insurance that fails to offer immunizations as a covered benefit or, lastly, having private insurance with high co-pays and/or deductibibles for preventive services. Little is know nationally about the adequacy of private insurance coverage of childhood immunizations.

OBJECTIVE:
We utilize data from several nationally representative surveys to impute rates of inadequate private insurance coverage for immunizations for US children 0-5 years of age.

METHOD:
We took estimates of private insurance coverage of US children 0-5 years of age from the 2000 Current Population Survey. To these estimates we applied rates of benefit coverage from two national surveys of employer health benefits that asked about coverage of childhood immunizations as a specific plan benefit. Lastly, surveys of US pediatricians on barriers to immunization delivery were used to provide futher information on financial barriers faced by children with private insurance. We combined these approaches to derive estimates of the proportion and total number of US children 0-5 with private insurance that face financial barriers to immunization.

RESULT:
In 2000, 16.64 million US children 0-5 years of age were covered by private insurance (employer group, private non-group, or Champus). Among privately insured children 21% or 3.479 million lacked coverage for childhood immunizations as a specific benefit. An additional 5.9% or 981,600 are estimated to have significant financial barriers to immunizations. Combining these, only 73.1% of privately insured young children in the US, or 12.1 million children 0-5 years of age, had adequate coverage for childhood immunizations.

CONCLUSION:
A substantial portion of privately insured children lack adequate coverage for immunizations. The Vaccines For Children program was developed to fill this gap. Many states have not taken full advantage of the VFC program for this population, leaving almost half with significant barriers to immunizations.

LEARNING OBJECTIVES:
Understand gaps in insurance coverage of immunizations in the US