BOX 3–4 Calculating the Size of the Child Population That Relies on State-Purchased Vaccines

Almost 600,000 children (15 percent) among the annual birth cohort of 3.88 million children in the United States lack health insurance, and an additional 1.2 million (31 percent) are enrolled in Medicaid plans.1 The committee estimates that the majority within this combined national population of 1.8 million infants (80 percent, or 1.44 million) are served by public and private health care providers that rely on VFC vaccines or SCHIP funds to serve their patients. This calculation leaves a residual need for the population of at-risk children (20 percent of 1.8 million, or 360,000 infants) who for some reason are not identified as VFC-eligible, or who otherwise depend on vaccines provided by local health clinics that are commonly purchased with Section 317 or state funds.2

An additional group of children (the “underinsured”) are enrolled in private health plans that lack coverage for vaccines. An estimated 8 percent of families with private health insurance do not have coverage for childhood immunizations (KPMG Peat Marwick, 1998). Their providers often refer them to local health clinics if they cannot cover vaccine costs out-of-pocket, but these children are not eligible for VFC, unless seen in federally qualified health centers, because they are insured. This population is estimated to represent between 4 and 5 percent of the annual birth cohort, or 170,000 infants.

The combination of 360,000 children who are eligible for but do not have access to the VFC/SCHIP programs and the 170,000 children who have private insurance but lack vaccine coverage totals 530,000 children (about 14 percent of the annual U.S. birth cohort) who rely on Section 317 or state-purchased vaccines for their immunization needs. This is one component of the safety net population commonly served by public health clinics. Other components include recent immigrants who have not yet met residency requirements that qualify them for Medicaid or SCHIP assistance, and adults aged 18 to 65 who do not have access to vaccines (see Box 3–3).

Immunization costs for children in the first 2 years of life are estimated at $400 (including $175 for vaccine purchase at federal contract rates [and not including pneumococcal conjugate], plus $225 in vaccine administration fees [$15 times 15 antigens]). Multiplying this $400 total immunization cost times the estimated 530,000 residual needs population derived above generates a total annual requirement of $212 million for early childhood vaccines alone.

Special note: An additional population that may be served by public health clinics deserves consideration in this discussion. In many communities, children who are enrolled in a Medicaid or SCHIP managed care plan request immunizations from their local public health clinics either because they have difficulty scheduling appointments with their own providers, because their providers are not participating in the VFC program, because they are responding to certain local outreach initiatives, or because of other special circumstances. However, the managed care plans in most states are priced to include the cost of purchasing and administering vaccines within the early childhood schedule. Several states and communities have successfully negotiated contracts that allow their public health clinics to bill



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