title: Is reimbursement for childhood immunizations adequate? evidence from two rural areas in colorado.
abstract: OBJECTIVE
  To assess adequacy of reimbursement for childhood vaccinations in two rural regions in Colorado, the authors measured medical practice costs of providing childhood vaccinations and compared them with reimbursement.
  
  
  METHODS
  A "time-motion" method was used to measure labor costs of providing vaccinations in 13 private and public practices. Practices reported non-labor costs. The authors determined reimbursement by record review.
  
  
  RESULTS
  The average vaccine delivery cost per dose (excluding vaccine cost) ranged from $4.69 for community health centers to $5.60 for private practices. Average reimbursement exceeded average delivery costs for all vaccines and contributed to overhead in private practices. Average reimbursement was less than total cost (vaccine-delivery costs + overhead) in private practices for most vaccines in one region with significant managed care penetration. Reimbursement to public providers was less than the average vaccine delivery costs.
  
  
  CONCLUSIONS
  Current reimbursement may not be adequate to induce private practices to provide childhood vaccinations, particularly in areas with substantial managed care penetration.
authors.affiliation: Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, CO 80262, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Glazner
authors.forename: J F
authors.initials: JF
authors.lastname: Steiner
authors.forename: K J
authors.initials: KJ
authors.lastname: Haas
authors.forename: B
authors.initials: B
authors.lastname: Renfrew
authors.forename: M
authors.initials: M
authors.lastname: Deutchman
authors.forename: S
authors.initials: S
authors.lastname: Berman
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics*; D003120:Colorado; D003151:Community Health Centers / Q000191:economics*; D003361:Cost Allocation; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007349:Insurance, Health, Reimbursement / Q000145:classification / Q000706:statistics & numerical data*; D008484:Medicaid; D008483:Medical Assistance; D010561:Personnel Staffing and Scheduling / Q000191:economics; D011331:Private Practice / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D013221:State Health Plans / Q000191:economics; D013996:Time and Motion Studies; D014481:United States