title: The influence of deductible health plans on receipt of the human papillomavirus vaccine series.
abstract: OBJECTIVE
  To evaluate whether enrollment in deductible health plans (DHP) with higher patient cost-sharing requirements than traditional health maintenance organization plans (HMP) decreased initiation and completion of the human papillomavirus (HPV) vaccine series recommended for prevention of cervical cancer.
  
  
  METHODS
  This was a retrospective observational study of 9- to 26-year-old females at Kaiser Permanente Georgia and Kaiser Permanente Colorado who were HPV vaccine naive at time of enrollment in a self-pay DHP or HMP in 2007. Estimates of rates of initiation and completion of the HPV vaccine series from plan enrollment in 2007 through December 2009 were obtained using Cox proportional hazards regressions (accounting for censoring) on samples matched on the propensity to enroll in a DHP versus HMP.
  
  
  RESULTS
  Initiation of the HPV vaccine series was 22.2% and 24.4% in the DHP and HMP groups, respectively, at Kaiser Permanente Georgia; completion was 12.3% and 14.4% in the DHP and HMP groups, respectively. Human papillomavirus vaccine series initiation was higher at Kaiser Permanente Colorado, but completion was lower. In the Cox proportional hazards regressions, rates of initiation and completion of the HPV vaccine series did not differ significantly (p ≤ .05) by plan type (DHP vs. HMP) at both sites. The primary care visit rate included in these regressions had a significant, positive association with initiation and completion of the HPV vaccine series.
  
  
  CONCLUSIONS
  Enrollment in a DHP versus an HMP did not directly affect initiation or completion of the HPV vaccine series among age-eligible females. Independent of plan type, more frequent primary care visits increased initiation and completion rates.
authors.affiliation: The Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, Georgia; School of Public Health, Georgia State University, Atlanta, Georgia.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Roblin
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. Electronic address: Debra.Ritzwoller@KP.Org.
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
authors.affiliation: Department of Economics, University of Colorado Denver, Denver, Colorado.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rees
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Nikki M
authors.initials: NM
authors.lastname: Carroll
authors.affiliation: The Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, Georgia.
authors.forename: Anping
authors.initials: A
authors.lastname: Chang
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003669:Deductibles and Coinsurance; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cancer; Deductible health plans; Health maintenance organizations; Human papillomavirus vaccine; Patient cost sharing; Preventive care