Could Medicaid up flu shots to poor kids?

A new study hints that higher Medicaid reimbursement rates could help get more poor kids vaccinated against the flu.

Although the vaccine itself is provided free of charge to children covered by Medicaid, doctors are only reimbursed for about half the cost of administering it, researchers say.

“Family pediatricians feel they are losing money by giving shots,” said Dr. Byung-Kwang Yoo, of the University of Rochester in New York, who led the new research.

“Just giving vaccines free to providers is not enough, so expanding coverage might be a good idea,” he added, stressing that he is not a pediatrician and that his study was funded by the government.

Yoo and colleagues tapped into data from the Centers for Disease Control and Prevention’s National Immunization Survey.

Since 2004, the CDC has urged parents to have infants between six and 23 months vaccinated against the flu, which causes tens of thousands of hospital admissions every year. Earlier this year, the recommendation was expanded to everyone six months and older.

While the number of vaccinated children climbed between 2006 and 2008, the researchers found, it still remained below a third nationally. And in kids living under the federal poverty level, it was as low as 19 percent.

Yoo said Mississippi had the lowest rate, at less than two in 100 kids, whereas Rhode Island came in first, at 40 in 100.

“We wondered what could explain the big variation between states,” Yoo told Reuters Health.

Using mathematical models, he found reimbursements levels for Medicaid patients—anywhere between $2 and $18 depending on the state—played a big role, even after accounting for factors such as family income levels, ethnicity and parents’ education.

“There is a strong association between physician reimbursement rate by Medicaid and influenza vaccination rate in children,” said Yoo, whose findings appear in the journal Pediatrics.

On average, administrative costs (overhead, nurses’ time, etc.) are about $20 per shot, while Medicaid coverage is only $9. If all poor kids were to be vaccinated, Yoo found in a study last year, doctors could lose some $200 million.

“If we increase the reimbursement rate by $10 per child, we can expect an increase in vaccination rates of up to 10 percent,” he said.

Dr. Stephen Berman, a pediatrician at Children’s Hospital in Aurora, Colorado, who was not involved in the research, echoed the new findings.

“Many family physicians, because the reimbursement rates are so low, aren’t doing childhood immunizations,” he told Reuters Health. “If instead of losing money a physician actually made some money on vaccines, they would be much more willing to administer vaccines in their offices.”

“It is not a question of making a huge profit,” Berman added, “you are talking about covering the costs.”

Yoo said his team was currently looking into the net health cost of increasing reimbursement, taking into account the decreased burden of treating sick kids.

And before considering a national-level increase, he added, doing smaller-scale experiments would make sense.

SOURCE:  Pediatrics, October 18, 2010.