Patients, physicians forgo adult vaccines over cost and coverage concerns

Many adults forgo recommended vaccines because of cost, according to a new study, either because they couldn’t afford a vaccine or because their clinician thought a vaccine would not be covered by the patient’s insurance plan and therefore did not recommend it.

The study, “Primary care physicians’ perspective on financial issues and adult immunization in the Era of the Affordable Care Act,” published in January 2017 in Vaccine, sought to identify the barriers to adult vaccination by surveying general and family practitioners shortly after the Affordable Care Act was implemented. Clinicians were asked about how many of their adult patients deferred or refused vaccines because of cost, as well as how often physicians did not recommend vaccine due to poor reimbursement practices. The research team also assessed how familiar clinicians were with Medicare coverage of vaccines and the vaccine-specific provisions within the ACA.

Among physicians who routinely recommended adult vaccines, 24% of general and 30% of family physicians reported patients deferred or refused vaccines for financial reasons in most cases. Of those physicians who did not recommend vaccines to their patients, 35% did so because they thought their patient’s insurance would not cover it and 38% because they thought the patient could be vaccinated more affordably somewhere else.

In terms of reimbursement, physician dissatisfaction was the highest when it came to Medicaid and Medicare Part B. Additionally, the study reported that anywhere from 36% to 71% of physicians were unaware of how Medicare covered certain vaccines, with the range dependent on the vaccine in question. Thirty-seven percent of physicians were completely unaware and 19% admitted to knowing “a little” about the ACA provisions affecting adult vaccination when the survey was conducted in 2013-three years after the reform was signed into law.

The study notes that most vaccine-preventable deaths occur in adults, yet vaccination rates in this age group remain low despite. Stakeholder have called for increased education among physicians and more resources to address the financial barriers surrounding adult vaccination.

 

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