Does Private Insurance Adequately Cover Childhood Immunizations

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Does Private Insurance Adequately Cover Childhood
Immunizations?
David L Wood 1, Jon Gabel 2, Maris A Bondi 3 and
Molly E French3

• 1University of Florida, Dept. of Pediatrics,
  Jacksonville 2 Health Research and Evaluation
  Trust, Chicago, IL 3Partnership for Prevention
  Washington DC

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Background

• Financial barriers can decrease utilization of
  child immunizations
• Private Insurance gt Medicaid
• Thompson et al. JAMA. 2003
• Mustin et al. JAMA 1995
• Any insurance better than being uninsured
• Wood et al. Pediatrics 199596295-301 Jama
  1997 Rodewald LE, Arch Pediatr Adolesc
  Med. 1997.
• RAND HIEHigher co-payments reduce utilization of
  Imms Lurie et al. Am J Pub Health 1987
• Universal purchase increased Imm. rates for
  under- and un-insured in NC
• Freed G, et al. Arch Pediatr Adoles Med 1999

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Types of Financial Barriers

• 1) Uninsured
• 2) Underinsured---Medicaid
• Poor reimbursement for administration of vaccine,
  cost of denials
• 2) Underinsured---Private Insurance
• Childhood imm. not a covered benefit
• Large copayments for preventive care or large
  deductibles

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Some Relief Financial barriers

• VFC program helped address financial barriers
• Distributed free--reduced financial risk to
  providers
• Many states increased Medicaid administration
  feesincreasing incentive for providers
• Private Insurance underinsured covered unevenly
• VFC only states
• VFC states
• Universal purchase states

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AIMS

• Little is known about the rate of under-insurance
  for childhood immunization by private insurance
• We sought to estimate nationally
• lack of coverage of childhood immunizations
• Financial barriers due to
  co-payments and deductibles

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Methods Estimation Steps

• Private insurance coverage for population of 0-5
  age years of age group from 2000 CPS
• Distribution of insurance type (HMO, PPO, POS,
  FFS) within private insurance
• Immunization benefit coverage rate by insurance
  type
• Weighted average coverage rate across privately
  insured children
• Estimate proportion with financial barriers due
  to co-pays and deductibles

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Estimating insurance coverage

• Different national or large-scale surveys
• Current Population Survey (CPS)
• National Health Interview Survey (NHIS)
• Survey of Income and Program Participation (SIPP)
• Medical Expenditure Panel Survey (MEPS)
• Community Tracking Study (CTS)
• National Survey of Americas Families (NSAF)

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Types of Coverage Estimates

• From SIPP and MEPS
• Uninsured for entire year (6.3)
• Ever uninsured during past year (21.7)
• Uninsured current month (13.1)
• CPS uses annual period prevalence
• Recall biascloser to point estimate
• Annual turnover for insured population
  highinsurance estimates are snap shots

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Insurance Coverage for 0-5 year old children
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Number of Children by Insurance Type
In Thousands
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Estimating Benefit Coverage

• Partnerships for Prevention/Mercer National
  Benefit survey
• Percent of children in each insurance type (PPO,
  HMO, POS, FFS)
• Percent with immunizations as covered benefit
  within each insurance type

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2001 Partnership for Prevention Benefit Survey
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High Co-pays and Deductibles

• Estimated children with barriers due to high
  co-pays or deductibles.
• 8 of the 79 with private insurance AND coverage
  for immunizations turned away due to financial
  barriers
• 79 x 8 6.3
• Zimmerman R JAMA 1997278996-1000

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Coverage for Immunizations, US Children 0-5
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Conclusions

• Only approximately 73 of privately insured
  children have coverage for immunizations
• Only 46 of all children 0-5 have private
  insurance that covers immunizations.
• Almost 1/4 or of children lt 5 years of age have
  either no insurance or no coverage
• Co-pays and deductibles are a financial barrier
  to immunizations for a significant minority of
  privately insured children

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Trends in Private Insurance

• Employment-based premiums rising
• 200111 200213 2003-14
• Workers earnings increased by only 3/year
• Companies responding by
• Passing increased premium costs on to employees
• Monthly contribution/family increasing
• 1988-52 1993--124 2002--174
• Increasing co-paysvisits, drugs
• Increasing deductiblesup 37 2001-2002 (ppo)
• Offering plans with limited benefits, flex plan

Gabel et al. Health Affairs 2003117-126
KFF/HRET 2002 Summary of Findings
www.kaisernetwork.org/healthcast/kff/o5sep02
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Policy Implications

• IOM report solutions
• Mandated benefit coveragechanging ERISA requires
  new federal legislation
• First dollar legislation
• Eliminates co-pay/deductible barrier
• VFC /UP in all states
• Will allow privately insured with no Immunization
  coverage to receive vaccine in Medical Home
• Still have barrier of administration fees for
  privately underinsured
• Need annual national and state stats. insurance
  benefit coverage for children

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Study Limitations

• Insurance coverage difficult to measure
• Reliant on parent report
• Insurance coverage is a moving target
• Used 2000 CPS data and insurance coverage has
  changed
• Decrease in private insurance
• Increase in Medicaid/SCHIP

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Limitations

• Insurance benefit data are difficult to obtain
• Limited number of surveysMERCER, Kaiser/HRET
  survey, MEPS
• Benefits report reliable?
• Weighting on benefits survey for total US
• Do not sample employers with lt10 employees
• Estimates of high co-pays and deductibles
• Reliant on provider reports
• Population of providers sampled assumed to have
  nationally representative population

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