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<<   作成日時 : 2008/12/03 00:21   >>

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 私的健康保険に加入している子どもに予防接種をすると損をするので、10人中1人の医師は接種をやめようかと考えている。
 同じ予防接種をしても1/10は損をする一方で、40ドルの儲けとなる医師もいる。保険支払いに差があるが、医師はほとんど気づいていない。
 Dr. Herschel Lessinは、2006-2007年で、ワクチン接種での支出が2倍になったという。
 保健当局はこうした結果を心配している。1980年代に医師がワクチンプログラムから手を引いたことで、1989-91年の麻疹の流行がおき、11,000人の入院患者と123人の死者を出した。
 今年は、子どもに予防接種をさせない親が増えていて、米国で10年来もっとも麻疹が流行している。大流行のお膳立てをしている可能性がある。
 最初の研究は、約1,300人の小児科医と家庭医への調査で、約800人から返送があり。約半数は、コストのために少なくとも1つのワクチンの購入を遅らせた。約1/5はワクチンの保険支払いは適正でないと強く感じている。
 2番目の調査は、医師にワクチンの購入代金と私的保険の支払いを聞いたものである。5つの州の76人から返事があったが、返送は約20%と低く、多くは契約で保険支払額を話すことができないからである。
 肺炎球菌ワクチンでは、1接種あたりで40ドルの利益から11ドルの損失まであった
 これらの研究では、50%以上をまかなう政府支出のワクチンのついては見ていない。それは、無料で医師に配布され、管理料のみが支払われている。
 ニューヨークでは実際に政府調達ワクチンの方が私的保険の支払いより2-3倍も財政的に良いという医師もいる。しかし、24-physician pediatric practiceのLessin副社長は、薄利だが私的保険のワクチンも子どもに対する中心的な仕事の一つであり放棄はせず続けるという。家庭医の中にはとても頭の痛い問題だと思う医師もいる。
(書きかけ)
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Some Doctors May Give up Vaccines Because of Cost
Some doctors likely to quit giving shots, citing poor vaccine reimbursement from insurers
By MIKE STOBBE AP Medical Writer
ATLANTA December 1, 2008 (AP)
The Associated Press
http://abcnews.go.com/Health/ColdandFluNews/WireStory?id=6366349

画像vaccines kids
Michael Valdivia holds, Jakob Gutierrez, 5, as he receives an immunization shot from a school nurse in this file photo in Hialeah, Florida.
(Joe Raedle/Getty Images)

About one in 10 doctors who vaccinate privately insured children are considering dropping that service largely because they are losing money when they do it, according to a new survey.

A second survey revealed startling differences between what doctors pay for vaccines and what private health insurers reimburse: For example, one in 10 doctors lost money on one recommended infant vaccine, but others made almost $40 per dose on the same shot.

The survey was revealing even to some doctors. "Many physicians really weren't aware and that they were getting reimbursed so little," said Dr. Gary Freed of the University of Michigan, a co-author of both articles published in the December issue of the journal Pediatrics.

The studies are the first to attach numbers to doctors' long-simmering complaints that they are only breaking even ― or even losing money ― when they give shots.

"It's a pleasure to see a real study to show we're not just making this up," said Dr. Herschel Lessin, a pediatrician in Hopewell Junction, N.Y. who said his practice's spending on vaccines has more than doubled from 2006 to 2007.

Experts say there's no evidence that significant numbers of doctors are quitting the vaccination business yet because of financial concerns.

But health officials are worried. Reimbursement concerns were behind an exodus of doctors from vaccine programs in the 1980s, which contributed to a terrible resurgence of measles in 1989-91 that caused 11,000 hospitalizations and 123 deaths.

This year, U.S. measles cases rose to the highest level in more than a decade, mainly because some parents are opting out of getting their kids vaccinated.

Health officials fear that problem, along with doctor's economic concerns, could set the stage for bigger outbreaks in the future.

"This is a very important wake-up call," said Dr. Lance Rodewald of the U.S. Centers for Disease Control and Prevention, referring to the two new studies.

The first study was based on a mail-in survey last year of nearly 1,300 pediatricians and family physicians; nearly 800 responded.

About half said they had delayed buying at least one vaccine because of the cost. Roughly one in five said they felt strongly that reimbursement for the purchase and administration of vaccines was not adequate.

The second survey asked doctors what they paid for vaccines and how much they were reimbursed by private insurers. It was answered by 76 doctors in five states, representing about 20 percent of those asked to participate. Many contracts prevent doctors from talking about their spending and reimbursement for vaccinations, Freed said.

One example of the disparity was a vaccine that protects against pneumococcal disease. The per-dose difference ranged from a $40 profit to an $11 loss. A chickenpox vaccine netted some doctors $35 but cost others nearly $30 per dose.

The survey examined the cost of the vaccines and the expense of storage and related medical supplies. But it didn't look at administrative fees and staff time.

The studies did not look at the 50 percent or more of vaccinations paid for by government, which generally provides free vaccines to doctors and covers administrative fees.

In New York state, some doctors actually do better financially with the government vaccine program than they do on the private market, with the government's administrative fee double or triple what some private insurers pay. But some business-savvy doctors can still make at least a small profit on vaccines in the private market, said Lessin, who is vice president of a 24-physician pediatric practice.

Most pediatricians are likely to keep giving vaccinations to kids, partly because of altruism and partly because giving shots drives business. "For us to give up vaccines would hurt our core business because that's why kids come in," Lessin said.

But family practice doctors ― who are not as dependent on vaccinations for patients ― may decide the shots are too much of a financial headache, he added.

Indeed, the new studies reflected that schism: Overall 11 percent of physicians have seriously considered stopping vaccinations for privately insured patients. But 21 percent of family doctors felt that way, compared with just 5 percent of pediatricians.

The financial problem has been getting worse in recent years, as more vaccines have come on the market, experts say. Some have been unusually expensive, including Gardasil, a vaccine for girls against cervical cancer which is given in three doses over six months and is priced at about $375 for the series.

A government advisory panel studying the financial burden of vaccines is expected to submit proposals for changes in reimbursement practices to federal health officials next year.

――
On the Net:
Pediatrics: http://pediatrics.aappublications.org/
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1325-1331 (doi:10.1542/peds.2008-2038)
ARTICLE
Variation in Provider Vaccine Purchase Prices and Payer Reimbursement
Gary L. Freed, MD, MPHa,b,c, Anne E. Cowan, MPHb, Sashi Gregory, MPHb and Sarah J. Clark, MPHb

a Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan
b Child Health Evaluation and Research Unit
c Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan

OBJECTIVE. The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers.

METHODS. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration.

RESULTS. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62.

CONCLUSIONS. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

Key Words: finance . payments . private practice . vaccine . private insurers

Abbreviations: ASP―average sales price . AWP―average wholesale price . CDC―Centers for Disease Control and Prevention . MSA―metropolitan statistical area

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PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1319-1324 (doi:10.1542/peds.2008-2033)
ARTICLE
Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations
Gary L. Freed, MD, MPHa,b,c, Anne E. Cowan, MPHb and Sarah J. Clark, MPHb

a Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan
b Child Health Evaluation and Research Unit
c Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan

OBJECTIVES. The purpose of this research was to explore physicians’ attitudes and behaviors related to vaccine financing issues within their practice. Amid the increasing number of vaccine doses recommended for children and adolescents, anecdotal reports suggest that physicians are facing increasing financial pressures from vaccine purchase and administration and may stop providing vaccines altogether to privately insured children. Whether these sentiments are widely held among immunization providers is unknown.

METHODS. We conducted a cross-sectional mail survey from July to September 2007 of a random sample of 1280 US pediatricians and family physicians engaged in direct patient care. Main outcome measures included delay in the purchase of specific vaccines for financial reasons; reported decrease in profit margin from immunizations; and practice consideration of whether to stop providing all vaccines to privately insured children.

RESULTS. The response rate was 70% for pediatricians and 60% for family physicians. Approximately half of the respondents reported that their practice had delayed the purchase of specific vaccines for financial reasons (49%) and experienced decreased profit margin from immunizations (53%) in the previous 3 years. Twenty-one percent of respondents strongly disagreed that "reimbursement for vaccine purchase is adequate," and 17% strongly disagreed that "reimbursement for vaccine administration is adequate." Eleven percent of respondents said their practice had seriously considered whether to stop providing all vaccines to privately insured children in the previous year.

CONCLUSIONS. Physicians who provide vaccines to children and adolescents report dissatisfaction with reimbursement levels and increasing financial strain from immunizations. Although large-scale withdrawal of immunization providers does not seem to be imminent, efforts to address root causes of financial pressures should be undertaken.

Key Words: finance . reimbursements . immunization . vaccine . private providers

Abbreviations: PCV7―heptavalent pneumococcal conjugate vaccine . AAP―American Academy of Pediatrics . AMA―American Medical Association . MD―allopathic physician . DO―osteopathic physician . HPV―human papillomavirus vaccine . MCV4―meningococcal conjugate vaccine

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