Chances are, if you were born and raised in the United States sometime in the last 70 years, you were immunized against a whole host of communicable diseases, from Measles, Mumps and Rubella, to Polio. Undoubtedly, vaccines have been touted among public health’s greatest accomplishments of the last century. Yes, millions of lives have been saved as immunizations represent the promise of modern biomedicine: disease prevention 1. As far as health promotion goes, preventive measures – inclusive of vaccines – take the cake on a public health approach to improving the community health and well being. However, the history of vaccines and the current policy provisions leave a convoluted labyrinth of issues like insurance coverage, safety concerns, vaccine supply, and public fear of immunizations for the average consumer to wade through 2. As new health reform provisions move into effect this year, patient awareness of vaccine delivery and preventive care policies is more important than ever.
As we well know, immunizations are developed to improve our immunity to a particular disease by introducing a disease-causing agent often made from weakened forms of the microbe, or its toxins. Our bodies are then prepared to recognize the agent, destroy it and flag it in-case it ever enters the system again. However, in the case of childhood vaccines, most are introduced in order to produce what is known as herd or population immunity. That is, because a certain proportion of the population has been immunized against a vaccine-preventable disease, there is lower likelihood that disease will continue to infect non-immunized individuals. In essence, the benefits of immunization are two-fold: first, we protect ourselves by biologically preparing our bodies to fight off infectious diseases and two, we provide added benefit to our community by collectively mitigating the spread of disease. Unfortunately, the vaccine market has been fraught with cost-sharing tactics for an industry that continues to push for the ever-growing list of recommended vaccines. In 1995, the cost of immunizing a child up to age 12 was $155. In 2007, those costs grew to $927 for boys and $1,217 for girls. This raises considerable concern for the 16 percent of insured families whose health coverage either doesn’t provide preventive services or whose deductible is too high to afford them. This translates into as many as 2.3 million under-insured children across 30 different states surveyed 3.
While not everyone agrees with the passage of the health reform bill in March 2010, the provisions in terms of prevention and community health were substantial, especially for children. Beginning this year, all health plans, including private insurance companies, and public plans like Medicaid, will be required to offer preventive services without cost-sharing imposed on patients. This means that services including regular well-baby visits, cancer screenings, and recommended immunizations for children and adults will be accessible without having to fork over out-of-pocket payments like co-pays or co-insurances 4. This is a win for consumers who have felt the sting of rising out-of-pocket costs for years and who may have opted out of these preventive services because of the cost of care. In a 2000 study by Solanki, Schaufler, and Miller, cost sharing was shown to negatively affect patient’s ability to receive essential preventive care like mammograms, pap smears, and counseling 5. By reducing or eliminating cost-sharing tactics, patients have the freedom to access these important prevention services, as needed or requested.
Additional provisions in the health reform bill encourage the development of patient-centered medical homes in which clinicians and patients are engaged as shared decision makers, with a focus on prevention goals and care coordination 6. The Picker Institute, along with Harvard University developed the eight dimensions of patient-centered care, including: (1) respect for the patient’s values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between health care settings; (7) physical comfort; and (8) coordination of care 7. It is clear that these domains have room for improvement, especially within the area of childhood vaccinations, in which patient-centered extends to family-centered. Parents should continue to be viewed as active partners in their child’s health and wellness needs, and particular respect for patient values, preferences, needs, and continuity of care will need to be a focus for the health care system, moving forward.
Ultimately, there is clearly room for growth in childhood vaccine delivery and preventive care. As health reform moves forward and the US health system begins to respond to the needs of American families, we hope to see that growth in unprecedented ways. Through the strategies of removing prohibitive cost-sharing barriers and developing of partnerships between health providers and patients, we hope to count on comprehensive, appropriate, and patient-centered care that is made a reality for our children, our families, and our communities.
1. H. Markel, “Taking Shots: The Modern Miracle of Vaccines,” Medscape, 23 June 2004.
2. Stern A, Markel H. (2005). “The History of Vaccines and Immunizations: Familiar Patterns, New Challenges. Health Affairs. 24. No.3
3. Bowman L. (2008). “Cost of vaccines puts them out of reach of many.” Scripps Howard News Service.
4. The Affordable Care Act’s New Rules on Preventive Care and You http://www.healthcare.gov/law/provisions/preventive/index.html
5. Solanki, G., H. H. Schauffler, and L. S. Miller. 2000. ‘‘The Direct and Indirect Effects of
Cost-Sharing on the Use of Preventive Services.’’ Health Services Research 34 (6):
1331–50.
6. Kocher R, Emanuel EJ, DeParle NM. (2010). The Affordable Care Act and the future of clinical medicine: The opportunities and challenges. Annals of Internal Medicine 153(7).
7. “Eight Dimensions of Patient-Centered Care. http://www.nrcpicker.com/Measurement/Understanding%20PCC/Pages/DimensionsofPatient-CenteredCare.aspx