title: The cost of giving childhood vaccinations: differences among provider types.
abstract: OBJECTIVE
  To describe costs to providers of delivering childhood immunizations.
  
  
  METHODS
  We collected variable costs--costs that vary with the amount of services rendered--including cost of practitioner and staff time and supplies, using a cost accounting method, from 12 practices (4 pediatric practices, 4 family practices, and 4 public health agencies) in rural and urban areas in Colorado. For private practices, we estimated fixed costs--costs that do not vary with the amount of services, eg, rent and insurance). We also collected reimbursement information for vaccinations for private practices.
  
  
  RESULTS
  Variable costs per shot (excluding vaccine cost) were 8.15 dollars for pediatric practices, 5.79 dollars for family practices, and 5.41 dollars for public health agencies. Total costs per shot, including fixed costs, were 10.67 dollars for pediatric practices and 7.57 dollars for family practices. Average reimbursement for pediatricians and private family practices was 8.27 dollars and 6.68 dollars, respectively. For pediatric practices, average variable costs were barely exceeded by average reimbursement, and reimbursement was 22% less than average total costs. This contrasts with an earlier study of the rural practices investigated here, in which there was a comfortable margin between reimbursement and variable costs.
  
  
  CONCLUSIONS
  The decline in the ratio of reimbursement to cost for private practices, particularly for pediatric practices, suggests that referral to public agencies by private providers for vaccinations may increase and that if vaccinations are not as frequently provided in the child's medical home, then the currently high childhood immunization rates may be in jeopardy.
authors.affiliation: Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Glazner
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Kellyn A
authors.initials: KA
authors.lastname: Pearson
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
mesh_terms: D002662:Child Health Services / Q000191:economics*; D002675:Child, Preschool; D003120:Colorado; D003625:Data Collection; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics*; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics; D010372:Pediatrics / Q000191:economics*; D011331:Private Practice / Q000191:economics; D011634:Public Health / Q000191:economics; D013996:Time and Motion Studies; D014611:Vaccination / Q000191:economics*