Vaccines: Bad Business for Doctors?
We in America seem to take the ready availability of vaccines for granted. Every so often there's a shortage of one vaccination or another, but for the most part we feel confident that we and our children will have access to the shots that protect us against a wide range of diseases, from measles to mumps to pertussis to polio.
But a pair of studies in the December issue of Pediatrics raises the alarming notion that doctors could, in fact, opt out of providing vaccinations for their privately insured patients.
Why would physicians be tempted to drop the shots? Money.
In a survey of 1,280 doctors, Gary Freed, a professor in the department of health management and policy at the University of Michigan's School of Public Health and the studies' lead author, found that nearly half had delayed purchase of a vaccination because of its cost. And 11 percent of those surveyed said they had considered ceasing to provide immunizations altogether because they don't get reimbursed enough to make their purchase and administration financially worthwhile.
That sentiment was particularly prevalent among family physicians. Sarah Clark, research assistant professor of pediatrics at the University of Michigan School of Medicine and one of the researchers working with Freed, says that's particularly disturbing. "Often in rural or medically under-served communities whose populations can't support a pediatrician, the family physician's all you've got," Clark says. If the local family physician stops offering vaccination, she says, people in those communities have nowhere else to turn for immunization.
The second survey, of 76 private-practice physicians, asked the doctors how much their practices paid for various vaccines and how much of that cost was reimbursed by insurance. Their answers illustrate the messy fiscal issues these doctors grapple with: the difference between the maximum and minimum prices practices they paid ranged from $4 to more than $30 for specific vaccines. As for insurance reimbursement, maximum and minimum reimbursements for a single vaccine differed anywhere from $8 to more than $80.
The authors make clear that, at least among pediatricians, wholesale abandonment of immunizations is not imminent. But, especially in light of recent measles outbreaks -- many of which apparently have stemmed from parents deciding not to immunize their children out of fear that the vaccine causes autism-- it's worth taking a moment to think about what our world might be like if they did.
Jennifer LaRue Huget
December 3, 2008; 7:00 AM ET
Categories: The Business of Health
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