From the Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA (FOM); Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA (MP, AM, JH, VF); Department of Health Care Policy, Harvard Medical School, Boston, MA (JPN, JH); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health (JPN); Harvard Kennedy School, Cambridge, MA (JPN); National Bureau of Economic Research, Cambridge, MA (JPN); Department of Medicine, Harvard Medical School, Boston, MA (AM, JH, VF).
J Am Board Fam Med. 2024 Mar 11;37(1):137-146. doi: 10.3122/jabfm.2023.230170R2.
Many adolescents do not receive basic preventive care such as influenza vaccinations. The Affordable Care Act (ACA) temporarily increased Medicaid reimbursements for primary care services, including vaccine administration, in 2013 to 2014. The objective of this study is to assess the impact of reimbursement increases on influenza vaccination rates among adolescents with Medicaid.
This repeated cross-sectional study used a difference-in-difference approach to compare changes in annual influenza vaccination rates for 20,884 adolescents 13 to 17 years old covered by Medicaid with adequate provider-reported data in 18 states with larger extended (>$5, 2013 to 2019) versus larger temporary (2013 to 2014 only) versus smaller reimbursement changes. We used linear probability models with individual-level random effects, adjusting for state and individual characteristics and annual time trends to assess the impact of a Medicaid vaccine administration reimbursement increase on annual influenza vaccination.
Mean Medicaid reimbursements for vaccine administration doubled from 2011 to 2013 to 2014 (eg, from $11 to $22 for CPT 90460). States with smaller reimbursement changes had higher mean reimbursements and higher adjusted vaccination rates at baseline (2011) compared with states with larger temporary and extended reimbursement changes. The reimbursement change was not associated with increases in influenza vaccination rates.
Influenza vaccination rates were low among adolescents with Medicaid throughout the study period, particularly in states with lower Medicaid reimbursement levels before the ACA.
That reimbursement increases were not associated with higher vaccination rates suggests additional efforts are needed to improve influenza vaccination rates in this population.
许多青少年未能接受流感疫苗等基本预防保健。《平价医疗法案》（ACA）在 2013 年至 2014 年期间暂时提高了医疗补助计划对初级保健服务（包括疫苗接种）的报销额度。本研究旨在评估报销额度增加对有医疗补助的青少年流感疫苗接种率的影响。
本重复横断面研究采用差异中的差异方法，比较了在 18 个州中，20884 名 13 至 17 岁有医疗补助、提供者报告数据充分的青少年的年度流感疫苗接种率的变化，这些州的扩大（>5，2013 年至 2019 年）、临时扩大（仅 2013 年至 2014 年）和较小的报销变化。我们使用个体水平随机效应的线性概率模型，调整了州和个体特征以及年度时间趋势，以评估医疗补助疫苗接种报销增加对年度流感疫苗接种的影响。
从 2011 年到 2013 年至 2014 年，疫苗接种管理的医疗补助报销平均增加了一倍（例如，从 CPT 90460 的 11 美元增加到 22 美元）。与临时和扩大报销变化较大的州相比，报销变化较小的州的平均报销较高，调整后的疫苗接种率在基线（2011 年）也较高。报销变化与流感疫苗接种率的增加无关。
在整个研究期间，有医疗补助的青少年的流感疫苗接种率较低，尤其是在 ACA 之前医疗补助报销水平较低的州。
报销增加与较高的疫苗接种率无关，这表明需要在这一人群中进一步努力提高流感疫苗接种率。
