title: Policy implications of first-dollar coverage: a qualitative examination from the payer perspective.
abstract: OBJECTIVE
  Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practices-recommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates.
  
  
  METHODS
  This was a qualitative study, using a literature review and semistructured expert interviews with payers.
  
  
  RESULTS
  Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons.
  
  
  CONCLUSIONS
  We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders.
authors.affiliation: NORC at University of Chicago, 4350 East West Hwy., Ste. 800, Bethesda, MD 20814, USA. Shortridge-emily@norc.org
authors.forename: Emily F
authors.initials: EF
authors.lastname: Shortridge
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Moore
authors.forename: Heidi
authors.initials: H
authors.lastname: Whitmore
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Grady
authors.forename: Angela K
authors.initials: AK
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017047:Cost Sharing; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D007407:Interviews as Topic; D058991:Patient Protection and Affordable Care Act; D011640:Public Policy; D014481:United States; D014611:Vaccination / Q000191:economics*