The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake
The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake
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DOI：
10.3390/vaccines5010008
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发表时间：
2017-03-01
期刊：
影响因子：
7.8
通讯作者：
Lindley, Megan C.
中科院分区：
文献类型：
--
作者：
Stoecker, Charles;Stewart, Alexandra M.;Lindley, Megan C.
先前的研究表明，费用分担和缺乏保险范围减少了低收入者使用预防性服务的情况。州医疗补助政策可能会影响推荐的成人疫苗接种。我们考察了医疗补助福利设计的三个方面(疫苗覆盖范围、禁止费用分担和共同支付金额)对19-岁的按服务付费的医疗补助人群中疫苗接种率的影响。我们结合了之前发布的报告，获得了2003至2012年的州医疗补助政策信息。有关流感疫苗接种的数据来自行为危险因素监测系统。我们使用了差异差异框架，控制了国家趋势和州差异，以评估每个福利设计因素对不同符合医疗补助条件的人群接种疫苗的影响。每多支付1美元的疫苗接种费用，流感疫苗接种覆盖率就会下降1-6个百分点。覆盖疫苗或禁止费用分担的效果好坏参半。实行疫苗接种的共付金与较低的疫苗接种覆盖率有关。这些发现对目前实行共同支付的州扩大医疗补助的实施具有影响。
Prior research indicates that cost-sharing and lack of insurance coverage reduce preventive services use among low-income persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts) on vaccine uptake in the fee-for-service Medicaid population 19-64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. Each additional dollar of copayment for vaccination decreased influenza vaccination coverage 1-6 percentage points. The effects of covering vaccines or prohibiting cost-sharing were mixed. Imposing copayments for vaccination is associated with lower vaccination coverage. These findings have implications for the implementation of Medicaid expansion in states that currently impose copayments.