The Topsy Turvy World of Vaccines
In 1993, after a failed attempt at health care reform, the Clinton administration passed the Vaccines for Children (VFC) program, a federally funded program that provides vaccines for uninsured and low income children at no cost to participating medical facilities. In a way, this program was a consolation prize for legislators who had to give up a much bigger vision for health care, and within its scope of action, the program has been a success. The support it has provided for clinics and private offices struggling under the burden of vaccine overhead has been invaluable. The way the program works is that the Center for Disease Control (CDC) buys vaccines at a discount, and distributes them to public health agencies who in turn give the vaccine to local clinics or private practices for distribution. The nurses and public health officials involved in the program are passionate about children’s health, and the program is run in a way that is helpful and supportive to the providers. In fact, this program is so good that the traditional system of fee for service for vaccines is on the verge of disappearing.
The original intent of the VFC program was to provide vaccines for disadvantaged children who might not otherwise get them; to compliment the existing fee-for-service system of vaccine administration--not replace it. In fact, specific provisions were written into the law, exempting anyone with insurance from accessing free VFC vaccine--except there was one loophole. If you went to a public health department, you could get “free”* vaccine whether you had insurance or not. Ironically, the program has contributed to an environment where now, children with insurance can have a harder time accessing vaccine than those without.
VFC is so efficient and convenient that hardly any one wants to to take on the hassles of purchasing private vaccine anymore, and many offices and clinics have ceased to provide them. There are several reasons for this:
1. Overhead: Vaccines are expensive. At any given time a moderate sized pediatric office can run $50,000-$100,000 overhead on vaccines.
2. Risk: Vaccines can be ruined by improper storage and handling, they can expire, and estimating the correct number of doses can be tricky. It is easy to lose a large investment if you make any number of possible mistakes.
3. Lack of Profit: Insurance companies will underpay or deny payment anytime they can. Without due vigilance to vaccine reimbursement, you can lend up subsidizing your vaccine program instead of profiting from it.
4. Inconvenience: The number and variety of vaccines can be overwhelming. It is time consuming to order and stock a wide variety of private vaccines for a relatively small number of children.
5. Unpopularity. If you don’t stock private vaccines, you don’t have to waste time trying to talk reluctant insured parents into vaccinating. This saves time and money, since it is often the insured families who are most suspicious of vaccination.
6. People have other options! Why go though the risk, hassle and headache of dealing with private vaccine when patients with insurance can just go their local health department and get them there? Private offices can’t give VFC vaccine to insured patients, but the public health department can. In allowing this, the government gives the message to insurers that it is not serious about requiring them to cover vaccines. In fact, on 9/30/2010 governor Schwarzenegger vetoed AB 2093, a California bill that would have required insurers to reimburse physicians adequately for the cost of purchasing, storing and administering vaccines.
Overall, the way vaccine administration is done (or not done) reflects the dysfunction in the way health care is delivered in this country. On the one hand, the federal Vaccines for Children program makes sense. Every child should be vaccinated, and as adults we have a moral obligation to provide this protection for all children. It serves our best interest as a society to produce and distribute vaccines in a coordinated manner so that we all benefit from the reduction in circulating infectious diseases in a cost effective way. On the other hand, what is actually happening for a portion of the population is that effective roadblocks have been put up so that insurance companies can maintain profits. I don’t know what Schwarzenegger was thinking when he vetoed AB 2093. Maybe he felt that government should stay out of private industry, or maybe he reasoned that these issues could be successfully hashed out without government intervention. Maybe he just doesn’t care if the children in California are adequately vaccinated. I don’t know. But what he has effectively done with this veto, and with other actions that fail to hold the insurance industry accountable, is to send larger and larger numbers of people to local public health departments where the government will pick up the cost for vaccinating them, after the insurance industry has collected their premiums. Where is the sense in that?
*providers are allowed to charge an administration fee in certain cases
In 1993, after a failed attempt at health care reform, the Clinton administration passed the Vaccines for Children (VFC) program, a federally funded program that provides vaccines for uninsured and low income children at no cost to participating medical facilities. In a way, this program was a consolation prize for legislators who had to give up a much bigger vision for health care, and within its scope of action, the program has been a success. The support it has provided for clinics and private offices struggling under the burden of vaccine overhead has been invaluable. The way the program works is that the Center for Disease Control (CDC) buys vaccines at a discount, and distributes them to public health agencies who in turn give the vaccine to local clinics or private practices for distribution. The nurses and public health officials involved in the program are passionate about children’s health, and the program is run in a way that is helpful and supportive to the providers. In fact, this program is so good that the traditional system of fee for service for vaccines is on the verge of disappearing.
The original intent of the VFC program was to provide vaccines for disadvantaged children who might not otherwise get them; to compliment the existing fee-for-service system of vaccine administration--not replace it. In fact, specific provisions were written into the law, exempting anyone with insurance from accessing free VFC vaccine--except there was one loophole. If you went to a public health department, you could get “free”* vaccine whether you had insurance or not. Ironically, the program has contributed to an environment where now, children with insurance can have a harder time accessing vaccine than those without.
VFC is so efficient and convenient that hardly any one wants to to take on the hassles of purchasing private vaccine anymore, and many offices and clinics have ceased to provide them. There are several reasons for this:
1. Overhead: Vaccines are expensive. At any given time a moderate sized pediatric office can run $50,000-$100,000 overhead on vaccines.
2. Risk: Vaccines can be ruined by improper storage and handling, they can expire, and estimating the correct number of doses can be tricky. It is easy to lose a large investment if you make any number of possible mistakes.
3. Lack of Profit: Insurance companies will underpay or deny payment anytime they can. Without due vigilance to vaccine reimbursement, you can lend up subsidizing your vaccine program instead of profiting from it.
4. Inconvenience: The number and variety of vaccines can be overwhelming. It is time consuming to order and stock a wide variety of private vaccines for a relatively small number of children.
5. Unpopularity. If you don’t stock private vaccines, you don’t have to waste time trying to talk reluctant insured parents into vaccinating. This saves time and money, since it is often the insured families who are most suspicious of vaccination.
6. People have other options! Why go though the risk, hassle and headache of dealing with private vaccine when patients with insurance can just go their local health department and get them there? Private offices can’t give VFC vaccine to insured patients, but the public health department can. In allowing this, the government gives the message to insurers that it is not serious about requiring them to cover vaccines. In fact, on 9/30/2010 governor Schwarzenegger vetoed AB 2093, a California bill that would have required insurers to reimburse physicians adequately for the cost of purchasing, storing and administering vaccines.
Overall, the way vaccine administration is done (or not done) reflects the dysfunction in the way health care is delivered in this country. On the one hand, the federal Vaccines for Children program makes sense. Every child should be vaccinated, and as adults we have a moral obligation to provide this protection for all children. It serves our best interest as a society to produce and distribute vaccines in a coordinated manner so that we all benefit from the reduction in circulating infectious diseases in a cost effective way. On the other hand, what is actually happening for a portion of the population is that effective roadblocks have been put up so that insurance companies can maintain profits. I don’t know what Schwarzenegger was thinking when he vetoed AB 2093. Maybe he felt that government should stay out of private industry, or maybe he reasoned that these issues could be successfully hashed out without government intervention. Maybe he just doesn’t care if the children in California are adequately vaccinated. I don’t know. But what he has effectively done with this veto, and with other actions that fail to hold the insurance industry accountable, is to send larger and larger numbers of people to local public health departments where the government will pick up the cost for vaccinating them, after the insurance industry has collected their premiums. Where is the sense in that?
*providers are allowed to charge an administration fee in certain cases
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