The vaccination debate: Better balance needed between public and private entities

By Matt Kuhrt

Despite the public sound and fury surrounding childhood vaccination in the United States, rates remain generally high. The cost of vaccination efforts have fallen disproportionately on physicians, however, according to a post on the Health Affairs blog, and increased help from the public sector is essential to maintain or improve upon the situation going forward.

Over half of the current supply for vaccines comes from the Vaccines for Children program, established in 1993, through which the cost of the vaccine itself is paid by federal funds. The cost to administer vaccines, however, has increasingly outstripped reimbursement rates in many states, the post noted. Combined with overhead costs, practices wind up losing between $5 and $15 per dose of vaccine administered through the program. Policy solutions proposed in the article include federalization of the vaccine administration fee and an adjustment to a billing code, which pays per injection, penalizing doctors who administer combination vaccines.

Less tangibly, but no less costly, doctors have had to spend a significant amount of time and energy communicating with and educating parents on the benefits of vaccines. The fact that today's parents have not seen the widespread effects of diseases makes them less ready to appreciate the frustration doctors feel in having to explain the public health benefits of vaccination programs, according to the article.

As a result, physicians end up subsidizing a public benefit, in the form of stemming the spread of preventable diseases, by administering vaccinations at an overall loss, says the American Academy of Pediatrics. While clinicians have a stake in public health efforts, it may become more difficult to maintain such an effort over time without a better balance between the public health system and private providers. Without such cooperation, the Academy warns, "a delivery model that has been carefully built to benefit children may become a casualty of bureaucracy and communication flaws."

To learn more:
- read the article