Chattanooga: Vaccines need shot in the arm

The nation’s robust immunization programs over the years largely wiped out diseases such as polio, diphtheria and measles.

But variable insurance reimbursements for the growing number of recommended vaccines for children and teens are making it harder to avoid losing money on the shots, local pediatricians said.

“Vaccines are exorbitantly expensive to us,” said Dr. Marian May, pediatrician with Beacon Health Alliance in Chattanooga. “Reimbursement from insurance companies sometimes can come under the cost of the vaccine to us, so it’s something that we have to track very closely.”

A study published in this month’s issue of the journal Pediatrics showed about one in 10 physicians surveyed seriously had considered whether to stop providing all vaccines to privately insured children in the past year because of financial concerns. Another survey found compensation from insurance companies for vaccinations given to privately insured children varied widely, meaning doctors sometimes take a financial hit to give vaccines.

Some vaccines can be costly, particularly newer shots such as Gardasil, which prevents human papillomavirus. The vaccine costs about $375 for a series of three shots, and doctors can’t break even on those vaccines, said Dr. Peter Rawlings, a pediatrician at Pediatric Diagnostic Associates and former president of the Chattanooga and Hamilton County Medical Society.

The situation is better for standard vaccines such as measles, mumps and rubella, health professionals said. After the cost of purchasing the vaccine plus manpower and equipment needed to administer the shot, “we pretty much break even,” said Pam Peck, clinical coordinator at Pediatric Diagnostic Associates.

“But the bottom line is, we would not consider stopping vaccinations because we think it’s the right thing to provide for patients,” she said.

Some public health officials are concerned that if primary care physicians get out of the programs in the future, an influx of privately insured patients needing vaccines will put added pressure on public health departments geared to handle uninsured or publicly insured children. Also, children who don’t follow up at the public health department might end up missing their immunizations altogether.

“If you don’t give it in your office, you’re gonna decrease the compliance,” Dr. May said. “It’s kind of ‘Catch-22.’ You don’t want to discourage the vaccine because we have seen these illnesses directly kill children.”

STAYING THE COURSE

Local health officials, however, said they are not concerned about doctors making a mass exodus from immunization programs.

“Locally, our physicians are doing a fantastic job vaccinating our children, and we haven’t heard parents coming to us (the public health department) because their pediatricians aren’t carrying vaccine anymore,” said Tammy Burke, director of clinical services for the Chattanooga-Hamilton County Health Department.

Diseases such as mumps, polio and rubella largely have been wiped out by the country’s immunization efforts, she said, but those conditions still pose a risk. One infected child who may have caught a disease in another country could cause an outbreak if a group of U.S. children are not up on their vaccinations, Ms. Burke said.

The U.S. Centers for Disease Control and Prevention reported that rising costs of vaccines resulted in more doctors referring children to public health departments for shots. Many children then didn’t get them, which contributed to a resurgence of measles among preschool-age children between 1989 and 1991, the CDC reported.

In those years, state health departments reported 55,467 measles cases resulting in more than 11,000 hospitalizations and 166 suspected measles-related deaths, according to a CDC report.

“When you don’t have it around, people think, ‘We don’t need that shot anymore,’” Dr. Rawlings said. “But people die of measles. We don’t need measles around again.”