July 25, 2007 

This article was published previously in TN Medical Magazine  

INEQUALITY OF IMMUNIZATION COVERAGE IN TENNESSEE AND  THE US 

When you pick up the paper the headlines read; “Health Care System in Crisis”, “Reform needed in Health Care”, but all of this is generalized talk, action needs to begin with each and everyone of us. 

As a Practice Manager for Pediatric Clinics for over 18 years, I have witnessed amazing changes in the Health Care System. Yet immunizing our infants and children in Tennessee, and across the country, falls short for a number of reasons which I would briefly like to address.  

Vaccine shortages constantly plague our system. Last year, recommendations were made to give booster vaccines for Varicella, the chickenpox vaccine. The private sector medical clinics’; currently are unable to fully vaccinate the patients due to the manufacturers’ vaccine shortage. Therefore, the opportunity to vaccinate is being missed. Yesterday, I was informed that the Hepatitis A vaccine produced by one of the manufacturers is now on back order. Thankfully this is one of the few vaccines available by multiple companies. This shortage has occurred with Gardasil (the new HPV vaccine), MMRV – the combination MMR and Varicella vaccine (which is no longer being manufactured), the flu vaccine, Prevnar and a host of other immunizations.  

Reimbursement by insurance companies for vaccines many times does not cover the physicians cost of the vaccine. A recent trend that Pediatricians are seeing is one in which employers/insurance companies are putting maximum dollar limits on well benefits, which includes immunizations. The most common dollar limit for well benefits being seen is $ 300.00. While this is not ideal at any age, it is inexcusable for infants and children. During the first year of life, the average cost to a pediatrician to immunize a child is $ 850.00 for the current immunizations given. This does not include any nursing time, supplies needed, or any well child care. Speaking for the Pediatric community, we do not look at making a profit on the immunizations of children/infants. Pediatricians must, however, cover the cost of the vaccine, the nurses’ time to give the vaccine, documentation of the vaccine, and the cost of submitting claims and hoping you will receive your reimbursement from the insurance company in a timely fashion so you can pay the bill.    

The elected and appointed officials in the State of Tennessee need to pass legislation mandating that health insurance companies cover immunizations for infants, children and adolescents and that furthermore, physicians are reimbursed fairly for the immunizations. Have you ever walked into the grocery store and say you will pay 50 cents for a $2.00 loaf of bread and the grocery store agree to this. Yet, that is exactly the way it works with health insurance companies and their reimbursement to physicians.

The State of Tennessee has chosen not to allow private physicians/pediatric offices to administer VFC (Vaccine for Children) immunizations to patients that have private health insurance, but whose insurance will not pay for immunizations.  VFC is a federal program that furnishes vaccines for TennCare patients, those patients without insurance, American Indians, Eskimos’ and those that have insurance, but insurance does not cover the cost. Each state VFC program may select whether private offices can administer the VFC immunization to those without adequate wellness benefits. The State of Tennessee has chosen that rather than receiving the vaccines (immunization) in the physicians’ office, the parent must make an additional trip to the health department in order to vaccinate their child. This puts a hardship on the working parent, a contributing tax payer, as they have already taken time off for their child to be seen at the pediatricians’ office. 

I can only shake my head at what I see occurring not only in Eastern Tennessee, but in pediatric offices across the country. As I can only speak for Pediatricians, as a group, they have been traditionally what I will call “insurance blind”. What this term means is regardless if you are TennCare, Self –Pay or have private insurance your child is treated the exact same as the next child. Unfortunately, this no longer is the case in regard to vaccines/immunizations. Now if you are TennCare or have no insurance, you have a better chance of having your child vaccinated against disease at your pediatricians’ office then if you have private insurance.  

In summary, the only winners when it comes to immunizing our children are the vaccine manufacturers and the private insurance companies. It is time for all parents, grandparents, employers, pediatricians, and our elected officials to put a halt to the growing disparity of who shall and shall not receive vaccines. While I am not at all an advocate for socialized medicine, I believe that every infant, child, and adolescent should be immunized at their physicians’ office and that the cost be paid either by the federal government or by the private insurance companies.  
 
 

Pat Pendland

Practice Manager