Tuesday, March 18, 2008 - 4:20 PM

Private Provider Attitudes about Reimbursement for Immunization Services

Gary L. Freed, Sarah J. Clark, and Anne E. Cowan. Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, 300 North Ingalls, Room 6E06, Campus Box 5456, Ann Arbor, MI, USA

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to appreciate the attitudes of private immunization providers related to reimbursement for immunization.

Anecdotal evidence from private providers suggests that third-party reimbursement is inadequate to cover the costs of immunization, and that practices actually lose money on some vaccines. It has been suggested that private providers will discontinue immunization delivery if reimbursement does not improve.

To document explore the attitudes and perceptions of private immunization providers related to adequacy of reimbursement and its effect on their immunization practices.

In summer 2007, we conducted a mailed survey of a national random sample of pediatricians and family physicians in office-based primary care.

About half of respondents reported that their practice has delayed the purchase of a new vaccine due only to financial concerns, and about one in five reported that their practice has experienced a significant (>20%) decrease in profit margin from child immunizations. More than forty percent “strongly agree” that their practice would not give a vaccine if reimbursement was less than the purchase price. Approximately ten percent of respondents indicated that in the past year, their practice had seriously considered whether to stop providing all vaccines to privately insured patients due to cost/reimbursement issues; this proportion was higher among family physicians (vs pediatricians) and among those directly involved in practice decision-making about vaccine purchase.

Many private immunization providers report that reimbursement is inadequate, and a sizable number have delayed introducing a new vaccine in their practice due to economic concerns. However, a relatively small proportion have seriously considered discontinuing the administration of childhood immunizations.