Abstract
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.
Highlights
It is well-documented that having health insurance coverage is associated with greater likelihood of receiving recommended adult vaccines
Few studies examine the effect of insurance coverage for specific preventive services, one study using self-reported data found that insurance coverage for vaccinations was associated with increased vaccination uptake [3]
We used year fixed effects to control for secular trends in vaccination coverage at the national level, and state-specific fixed effects to control for time-invariant state-level differences in vaccine uptake and the characteristics of each state’s Medicaid population, since the groups covered by Medicaid differ widely from state to state
Summary
It is well-documented that having health insurance coverage is associated with greater likelihood of receiving recommended adult vaccines. This finding holds true across a range of adult subpopulations and vaccine types [1,2,3,4]. Few studies examine the effect of insurance coverage for specific preventive services, one study using self-reported data found that insurance coverage for vaccinations was associated with increased vaccination uptake [3]. Prior research shows that cost-sharing reduces use of medical care, including recommended preventive care [5], and that the resulting reductions in usage may disproportionately affect health outcomes for low-income individuals in poor health [6]. Prior to the passage of the Affordable Care Act (ACA), several private health insurance plans waived copayments for vaccination services [9]
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