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Background: School-located influenza vaccination can result in efficient vaccination of large numbers of children, but previous programs have rarely billed third party payers, hampering sustainability.
Objectives: To assess rates of vaccination; costs of conducting clinics; and billing and reimbursements for an elementary school-located influenza vaccination program that billed third party payers.
Methods: During the 2009-2010 season, influenza vaccination clinics were conducted in 20 elementary schools in the Denver Public School System. School personnel obtained parental consent, and local public and community health personnel verified insurance information, conducted the clinic, and performed billing. VFC vaccine was available for eligible students. Parents were not billed for any charges.
Results: Of 9,814 enrolled students, 28% (2,791) received ≥1 influenza vaccines at school; 21% received seasonal and 16% received H1N1 vaccine. Among children < 9 years who required 2 doses and attended the first clinic, 82% (382/465) received a 2nd dose. Fifteen percent of vaccinated students were privately insured, 55% were insured by the SCHIP or Medicaid, and 30% were uninsured. Hispanic children were more likely to attend a clinic (34%) than were non-Hispanic white (18%) or non-Hispanic black (15%) children (p<0.0001). The administrative costs to the public health entity and the school district for conducting clinics were approximately $18.76 per vaccination given. Of all billed claims for vaccines, 44% were reimbursed (58% of SCHIP; 36% of private insurance); 83% of billed administrative claims were reimbursed (88% of SCHIP; 94% of Medicaid; 45% of private insurance). Overall, 50% of total vaccine costs and 22% of total administration costs were reimbursed by third party payers.
Conclusions: A school-located influenza vaccination program vaccinated approximately 1/3 of elementary students and received reimbursement from third party payers for a portion of costs. Additional efforts are needed to improve reimbursement levels from third party payers to ensure sustainability.