Panel aims to close immunization gap

THE BALTIMORE SUN

WASHINGTON - In a plan to make sure Americans receive proper immunizations, a panel of experts said yesterday that the government should require all insurance plans to cover vaccinations and should provide vouchers to uninsured people for the recommended shots.

The proposals are designed to fill financing gaps in the immunization program, which the panel warned is in danger of becoming "outmoded and overburdened."

More than 28 million Americans - about 10 percent of the nation's population - do not receive some or all of the recommended immunizations. Under the plan announced yesterday, manufacturers would receive subsidies to encourage them to produce vaccines that have a special value to society. Insurers and doctors would be reimbursed for the cost of providing immunizations.

"We offer a plan that both ensures access to vaccines for those in need and creates incentives for private investment in the vaccine industry that would sustain the development and manufacture of these products in the future," said Frank A. Sloan, professor of health policy at Duke University and chairman of the Institute of Medicine panel that issued the report. The institute is an arm of the National Academy of Sciences.

Dr. Walter A. Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention, said the proposals are "a step in the right direction." Orenstein said it was too early to endorse the proposals but added, "The goals are goals we could ascribe to."

Members of the panel could not say how much the subsidies would add to the costs of vaccines, although the report noted that "substantial increases" in spending should be anticipated in the years ahead as new vaccines are developed. The federal government now buys 56 percent of the vaccines administered to children at an annual cost of $1 billion.

The cost of vaccines is already rising quickly, the report said. The cost of immunizing children with 20 recommended doses - at discounted government prices - jumped from $200 a child in 1997 to $400 in 2001. For private health plans, the cost in 2001 was about $600.

In the current system, the government and private insurers share responsibility for paying for vaccines but leave coverage gaps. Panel member Sara Rosenbaum, director of health policy research at George Washington University, said 8.5 million children are underinsured for vaccines and 20 million adults are underinsured or have no coverage at all.

"It was uppermost in our minds to close this gap," she said.

Children and adults who are not covered for all recommended vaccines are counted as underinsured. The CDC reported last week that immunizations prevent about 10.5 million cases of disease and 33,000 deaths a year.

In addition to coverage gaps, the report said panel members were concerned about widespread disparities in coverage. The CDC said that coverage for basic childhood immunizations ranges from 63 percent in Colorado to 86 percent in Massachusetts.

The panel's recommendation that all government and private health plans cover immunizations would require congressional approval. The panel also called for a voucher system to cover children and adults without insurance coverage. In both cases, health plans should be paid enough to cover their costs, the report said.

Dr. Donald A. Young, president of the Health Insurance Association of America, said many health plans already cover some immunizations but added the proposals were worth further consideration. Still, he said, "We believe the best health benefit design emerges from conversations among employers, employees and health plans."

Karen M. Ignagni, president of the American Association of Health Plans, said, "We like the goals" of improving immunizations. She said her trade group's only reservation is about the insurance mandate.

Sloan's panel of medical experts also raised concerns about the future availability of vaccines. Supply shortages appeared in 2001 and 2002, and the report said the number of companies producing vaccines for the U.S. market has declined from 25 to five over the past three decades.

The subsidies for manufacturers should be set before production, the report said, and should reflect the estimated savings that would be achieved through improved quality of life and enhanced productivity.

The Hartford Courant is a Tribune Publishing newspaper.

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