ability to influence prices because of the vaccine shortages and the smaller number of vaccine manufacturers.

Looking to the future, Dr. Rieg noted concerns at Kaiser about the cost of new vaccines, especially those for which demand is expected to be high, such as multivalent pediatric vaccines and an AIDS vaccine. The possibility has been raised that copayments or other forms of cost sharing with plan members will be necessary for immunization services. At the same time, there is concern that added member costs might tend to lower immunization rates. In addition, with the current shortages of several vaccines, the stability of the vaccine supply is of growing concern.


In the United States, most private health insurance coverage is obtained through plans offered by employers. Therefore, employers’ concerns and priorities play an important role in determining the coverage for immunizations available to many children and adults. Pamela Hymel, vice president for human resources at Hughes Corporation, discussed some of the factors that influence employer decisions.

At Hughes Corporation, coverage for preventive care in general and immunization in particular is seen as a good investment to improve productivity. Preventive care helps reduce absenteeism by reducing illness among employees and their children and helps control costs for treatment. Coverage for immunization and other preventive services also contributes to employees’ satisfaction with their health plans. Ms. Hymel noted that large employers have public health responsibilities that they can help meet by providing coverage for immunizations.

To encourage use of preventive services, Hughes Corporation tries to minimize both financial and logistical barriers. The company’s health insurance plans provide first-dollar coverage for immunizations. In addition, offering influenza immunizations at worksites makes that service more readily available to employees and reduces lost work time.

Data and measurement are important for employers’ assessments of the return on their investment in preventive services. Ms. Hymel noted that for its preferred provider organization plan, Hughes Corporation currently allocates 5 percent of its spending to preventive services. With indications of an acceptable return on investment, the company would be willing to increase those benefits. Health plan reports using various HEDIS measures help employers monitor whether employees and their families are receiving useful preventive services. Employers are also able to use HEDIS measures to establish quantitative performance standards for evaluating the health plans they offer. Good data on the costs and

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