Variation in patient charges for vaccines and well-child care
G. L. Freed, S. J. Clark, T. R. Konrad and D. E. Pathman
Division of Community Pediatrics, University of North Carolina at Chapel Hill, USA.
BACKGROUND: Several state and federal programs have attempted to boost
immunization rates by reducing or eliminating provider vaccine costs. The
relation between patient vaccine and well-child visit charges and vaccine
financing systems is unknown. OBJECTIVES: To determine patient charges for
vaccines and well-child visits in three states with varying vaccine
financing systems and to examine the effects of a short-term reduction in
provider vaccine costs. DESIGN: Cross-sectional survey study of a random
sample of physicians in three states. PARTICIPANTS: A total of 2797
pediatricians and family physicians in North Carolina, Texas, and
Massachusetts were surveyed. MAIN OUTCOME MEASURES: Current charges to
patients for diphtheria-tetanus-pertussis vaccine (DTP),
measles-mumps-rubella vaccine, Haemophilus influenzae type b vaccine (Hib),
and combined DPT-Hib vaccine for well-child visits; changes in charges over
the previous 8 months. RESULTS: Response rate was 62%. Vaccine and
well-child visit charges were comparable in North Carolina and Texas.
Massachusetts' average charges for well-child visits were higher than in
the other states, although vaccine charges were lower; with the use of
combined DPT-Hib vaccine, total simulated charges for vaccines and
well-child care during the first 6 months of life averaged only 10% less in
Massachusetts vs Texas and North Carolina. Neither regional variation in
cost of living nor Medicaid reimbursement rates explained this difference.
CONCLUSIONS: The average cost and composition of charges for well-child
care in Massachusetts, a state with universal purchase of vaccines,
compared with the other states, warrant further study to explore whether
physicians shift costs to other preventive services to compensate for lower
allowable immunization charges. If such cost shifting occurs, current
federal immunization initiatives that lower or eliminate provider cost may
not provide increased access to preventive services.
