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U.S. Immune System Faces Financial Stress

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Reimbursement woes may be hurting the U.S. immunization system.[@@]

A team of researchers led by Walter Orenstein reviews some of the financial considerations affecting the system in an article in the May-June issue of Health Affairs.

The editors of Health Affairs, a major health care finance and delivery journal, have devoted most of the 894-page issue to the U.S. and world immunization systems.

Weaknesses in the U.S. system include shortages of many vaccines, safety concerns and high prices, Orenstein’s team writes.

Although Medicaid, Medicare and other state and federal programs pay for many vaccinations, especially for children, private insurers also play a role, both for children and for adults, the researchers write.

About 57% of vaccines recommended for children were purchased through a federal contract, but private insurers pay for some vaccines for children, and private insurers reimburse adults for most adult vaccinations, according to Orenstein’s team.

“Reimbursement for vaccine administration is typically less than it costs to administer the vaccine,” the researchers write.

During the 1990s., vaccine providers earned more for vaccinating children than for vaccinating adults. But starting this year, Medicare will pay providers $18 per vaccination, which is more than state health programs pay for childhood vaccinations, the researchers write.

The researchers cite rapidly rising vaccine costs as one concern.

In February, the total cost for the vaccines that children are supposed to have before they enter elementary school was $474 when purchased through the federal contract and $782 when purchased privately.

The price of one new, 4-dose vaccination series, the pneumococcal conjugate vaccine series, is nearly equal to the cost of all other vaccines that a child should receive, according to Orenstein’s team.


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