title: Vaccine financing from the perspective of primary care physicians.
abstract: OBJECTIVE
  Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available.
  
  
  METHODS
  A national survey among private pediatricians and family physicians April to September 2011.
  
  
  RESULTS
  Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children's Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty.
  
  
  CONCLUSIONS
  Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.
authors.affiliation: Children's Outcomes Research, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Allison
authors.forename: Megan C
authors.initials: MC
authors.lastname: Lindley
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Laura P
authors.initials: LP
authors.lastname: Hurley
authors.forename: Michaela
authors.initials: M
authors.lastname: Brtnikova
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Christine I
authors.initials: CI
authors.lastname: Babbel
authors.forename: Andrea
authors.initials: A
authors.lastname: Jimenez-Zambrano
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000191:economics*; D014612:Vaccines / Q000191:economics*
chemical_list: D014612:Vaccines
keywords: adolescents; children; immunizations; primary care; vaccines