title: How might immunization rates change if cost sharing is eliminated?
abstract: OBJECTIVE
  There is a debate regarding the effect of cost sharing on immunization, particularly as the Affordable Care Act will eliminate cost sharing for recommended vaccines. This study estimates changes in immunization rates and spending associated with extending first-dollar coverage to privately insured children for four childhood vaccines.
  
  
  METHODS
  We used the 2008 National Immunization Survey and peer-reviewed literature to generate estimates of immunization status for each vaccine by age group and insurance type. We used the Truven Health Analytics 2006 MarketScan Commercial Claims and Encounters Database of line-item medical claims to estimate changes in immunization rates that would result from eliminating cost sharing, and we used the Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey to determine the prevalence of coverage for patients with first-dollar coverage, patients who face office visit cost sharing, and patients who face cost sharing for all vaccine cost components. We assumed that once cost sharing is removed, coverage rates in plans that impose cost sharing will rise to the level of plans that do not.
  
  
  RESULTS
  We estimate that immunization rates would increase modestly and result in additional direct spending of $26.0 million to insurers/employers. Further, these payers would have an additional $11.0 million in spending associated with eliminating cost sharing for children already receiving immunizations.
  
  
  CONCLUSIONS
  The effects of eliminating cost sharing for vaccines vary by vaccine. Overall, immunization rates will rise modestly given high insurance coverage for vaccinations, and these increases would be more substantial for those currently facing cost sharing. However, in addition to the removal of cost sharing for immunizations, these findings suggest other strategies to consider to further increase immunization rates.
authors.affiliation: U.S. Department of Health and Human Services, Washington, DC ; U.S. Agency for International Development, Washington, DC.
authors.forename: Angela K
authors.initials: AK
authors.lastname: Shen
authors.affiliation: The National Opinion Research Center at the University of Chicago, Bethesda, MD.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Grady
authors.affiliation: Towers Watson, Arlington, VA.
authors.forename: Roland D
authors.initials: RD
authors.lastname: McDevitt
authors.affiliation: The National Opinion Research Center at the University of Chicago, Bethesda, MD.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Pickreign
authors.affiliation: Towers Watson, Arlington, VA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Laudenberger
authors.affiliation: U.S. Department of Health and Human Services, Washington, DC.
authors.forename: Allahna
authors.initials: A
authors.lastname: Esber
authors.affiliation: The National Opinion Research Center at the University of Chicago, Bethesda, MD.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Shortridge
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017047:Cost Sharing; D019538:Health Care Surveys; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D022542:Measles-Mumps-Rubella Vaccine / Q000191:economics; D022401:Meningococcal Vaccines / Q000191:economics; D053918:Papillomavirus Vaccines / Q000191:economics; D022242:Pneumococcal Vaccines / Q000191:economics; D014481:United States; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data; D018074:Vaccines, Conjugate / Q000191:economics
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate