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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.

By Jennifer LaRue Huget  |  December 3, 2008; 7:00 AM ET
Categories:  The Business of Health  
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This illustrates our health care system: prevention is eschewed for cost to providers, and alternative medicine based on bad science gains more creedence. Look for more childhood morbidity and mortality.

Posted by: williamjohnson1 | December 3, 2008 9:15 AM | Report abuse

This one statement:

“Why would physicians be tempted to drop the shots? Money”

Is the reinforcement of already proven facts in the insurance, medical, and societal views of vaccinations. Vaccination rates are at their highest levels ever. There are more vaccines on the market then ever before. Are they all necessary? No. Are they all vital to every individual’s welfare? Also no. Are they cost effective versus the cost of treating the illness that the vaccine may prevent? Not always.

If the only thing preventing the doctor from administering vaccines is money, what does that tell you about the ethicist and standards of the doctor? If the insurance company does not see the cost savings of administering vaccines, what does that tell about the insurance companies? If both of these collective, knowledgeable entities do not see the usefulness of vaccines, what does that tell you about the vaccines?

Even in the examples in the article, there are stereotypical statements that illustrate a complete lack of knowledge concerning vaccines and are nothing more than hyperbole. The very limited number of measles cases, which is statistically less lethal than influenza, were primarily caused by foreign exposure. These cases were primarily in children under age to receive the vaccine, and those that were not vaccinated choose to do so due to philosophical reasons that have never been directly attributed to autism. There have been no deaths from any of these cases in the US.

In order to be a respectable, unbiased, reporter, you may want to actually start doing some research before writing your articles.

Posted by: | December 3, 2008 11:29 AM | Report abuse

Hmmm.. Well, some of you need to take, or retake, economics 101...
A 10 shot vial of dpt is hundreds of dollars... The various insurers will give me $2.50 for the syringe and the nurses time and maybe $8 for the vaccine... This is on top of their paying me an office call fee of 80% of the baseline cost of 2005 as modified by yadda, yadda, yadda - the bottom line is they pay me 50 cents on the dollar, or less (with medicaid/medicare it is much less)for the office visit so I am already giving away my services - and then to stiff me for the childs vaccine is adding insult to injury...
Now, if that vaccine is so important to you, the public, why are you not willing to pay me the hundreds of dollars it costs for a series of shots for their kids?
My experience is that the parents do not feel they should have to spend a penny on health care...It has been at least a dozen years since I have kept any vaccines in my office... The patients are advised to go to the county health department for their vaccinations...

I am sure some of you will wail that i am callous, greedy, etc... Where were you the time I did not have the money to pay my help and had to borrow from the bank to meet the payroll? Or the time I did not take home a paycheck for three and a half months because medicaid ran out of money and stopped paying any billings for 4 months and after I paid the help and the bills there was no cash left in the checking account?

Dr. O

Posted by: ad4hk2004 | December 3, 2008 12:41 PM | Report abuse

Dr. O.,

Glad to see you have joined the real world where lots of people get stiffed on their bills and wonder where they are going to get $$ to pay their next bills. I live and work in a large medical community and the lowest paid docs probably make $200K/year and McMansions are a dime a dozen. When push eventually comes to shove in medicine they won't be getting a huge amount of sympathy from the public.

Posted by: msgrinnell | December 3, 2008 12:50 PM | Report abuse

msgrinnell- Pray, tell, how many hundreds of thousands of dollars in student loan debt do you have? How many years of education and residency/internship/fellowship to you have? And how vital are you to the health of the country? Ya, doctors don't deserve anything over $200K a year. And clearly you don't know any GPs or pediatricians.

Posted by: atb2 | December 3, 2008 2:18 PM | Report abuse


If GPs are so vital to the health and well being of every citizen then why is there so much bureaucracy and debt involved in becoming a GP? Why is it so vitally necessary for every GP to go through residency/internship/fellowship to acquire skill sets that may never be required during a GP’s practice of general medicine? Is it the market’s fault that a GP’s salary cannot repay the cost of education or is it the GP’s fault for not having the foresight to be able to run a profitable business?

Posted by: | December 3, 2008 4:07 PM | Report abuse

Petty name-calling and bickering over who makes more money aside, this could be a serious problem for patients. If doctors do not carry vaccines, it may put patients in a no-man's land of insurance reimbursement (if you're lucky enough to have insurance). while many insurance providers do cover basic vaccinations, they often only cover them if dispensed by the office. If your doctor doesn't carry them, then the patient is left either to a) find a doctor who does, or b) pick up the vaccine at pharmacy and take it to the doctor to have it administered...and take your chances on reimbursement. Having chosen B before, a major insurance carrier told me that while it is covered under my medical plan, I couldn't be reimbursed because the doctor didn't file for reimbursement. I couldn't file a pharmacy claim because it's not a covered drug in my pharmacy plan. If doctors are forced to remove vaccines from their offices because of improper reimbursement, more patients will be stuck in limbo, where everyone agrees that it should be reimbursed but no one will agree to pay. Given that vaccines can cost hundreds of dollars, this could be a serious problem for many families.

Posted by: jlm21 | December 5, 2008 9:33 AM | Report abuse

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