NORC at University of Chicago, 4350 East West Hwy., Ste. 800, Bethesda, MD 20814, USA.
Public Health Rep. 2011 May-Jun;126(3):394-9. doi: 10.1177/003335491112600313.
Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practices-recommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates.
This was a qualitative study, using a literature review and semistructured expert interviews with payers.
Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons.
We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders.
预防儿童和成人面临生命威胁的疾病的免疫接种已被证明是 20 世纪公共卫生的巨大成就之一，而且极具成本效益。《患者保护与平价医疗法案》包含了若干增加免疫接种覆盖率和可及性的条款，包括要求健康计划按首笔费用（或无费用分担）支付所有免疫实践咨询委员会推荐的疫苗。在这项研究中，我们研究了支付方对疫苗首笔费用覆盖的看法以及提高疫苗接种率的策略。
这是一项定性研究，使用文献回顾和对支付方的半结构式专家访谈。
出现了 4 个关键主题，包括：(1) 首笔费用变化的成本影响；(2) 分别检查儿童、青少年和成年人的障碍以更具战略性地集中干预措施的重要性；(3) 提高免疫接种率的提供者知识和教育的重要性；以及(4) 首笔费用覆盖对因个人原因拒绝接种疫苗者的影响。
我们确定，虽然通过首笔费用覆盖来降低经济障碍是提高免疫接种率的重要第一步，但仍存在结构性和文化性障碍，这也需要所有疫苗利益相关者之间的协作和战略性工作。
