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Report Calls for Revised Vaccine-Payment Policies

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WASHINGTON--By buying vaccines from the U.S. Centers for Disease Control, states could save millions of dollars on immunizations for Medicaid recipients that could be used to improve childhood-immunization programs, according to the preliminary findings of a General Accounting Office report.

Moreover, states could save even more by requiring that combined vaccines be used instead of providing Medicaid reimbursement to clinics and doctors for injections of single-antigent vaccines, the report notes.

"States could lower their Medicaid vaccination costs by adopting more cost-effective vaccine-payment policies,'' said Mark V. Nadel, the G.A.O.'s associate director for health financing and policy issues in the agency's human-resources division.

"Savings on vaccine costs could allow states to use their limited financial resources to improve the effectiveness of their immunization programs, including developing or enhancing a tracking, outreach, and education system,'' he said.

Mr. Nadel made his remarks last week at a hearing on childhood immunizations held by the Senate Finance Subcommittee on Health for Families and the Uninsured. Although the G.A.O. report will not be released until later this year, Mr. Nadel previewed the findings for the panel.

$14.2 Million in Savings

Mr. Nadel testified that states could have saved $14.2 million in 1991 if they had purchased their vaccines through the C.D.C. rather than through commercial sellers.

Such savings would have been possible, he said, because the C.D.C. has contracted for the bulk purchase of vaccines for state and local health agencies. Manufacturers, he said, have lowered prices to make vaccines more available to poor children.

Illinois was one of 19 states that bought vaccines from the C.D.C. in 1991 and distributed them to Medicaid providers, including private doctors, Mr. Nadel said. Medicaid reimbursed the state health department for the vaccines, and the state saved $1.5 million that year.

States could also save money by requiring combined vaccines, he said.

A G.A.O. survey found that Medicaid reimbursements for single-antigent vaccines are 60 percent higher than those for a combined vaccine.

Cost a Factor

But states said in the survey that adopting such steps would be costly because a new system of handling and distributing vaccines would have to be established and because the traditional public-health role would have to be expanded.

The G.A.O. report will also include findings that show that the immunization programs in only 12 states have "integrated statewide'' tracking and education systems. In those 12 states, the immunization rate for preschool children was 66 percent, according to the G.A.O.; in the other states, the rate was 58 percent.

Senator Donald W. Riegle Jr., the Michigan Democrat who chairs the subcommittee, called the hearing to highlight a bill he introduced last fall, S 2116.

The bill would, among other things, establish a demonstration program for systematic immunization tracking, enhance outreach and education projects, and remove policy barriers that prevent some poor children from getting immunizations.

Christine Nye, the director of the Medicaid Bureau of the Health Care Financing Administration, said the Bush Administration has set a target of having 80 percent of all Medicaid-eligible children vaccinated by 1995.

But, she said, the Administration believes its goal can be reached without Mr. Riegle's bill.

She said "a key part'' of President Bush's health-care-reform plan is enrolling more Medicaid recipients in coordinated-care plans that emphasize preventive medicine and routinely provide immunizations.

Also at the hearing, Joseph Liu, a senior associate in the health division of the Children's Defense Fund, said many youngsters are not getting immunized because private doctors continue to refuse to treat children on Medicaid.

A C.D.F. survey conducted last fall indicates that states pay an average of 53 percent of the usual fees for the diphtheria, tetanus, and pertussis vaccine; 67 percent of the fees for the oral polio vaccine; 72 percent of the fees for the measles, mumps, and rubella vaccine; and 84 percent of the fees for the meningitis vaccine, Mr. Liu said.

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