Abstract
BackgroundThe introduction of new vaccines for young children requires instruments for a rapid and timely assessment of the progressively increasing vaccination coverage. We assessed whether routine data generated by statutory health insurances (SHI) might be used to monitor vaccination coverage in young children.MethodsFor 90% of the population Germany's healthcare system is premium-funded through SHI. Specific medical codes on childhood vaccination are used for billing. These were used to analyse vaccine uptake up to 24 months in children born in Bavaria between 2001–10–01 and 2002–12–31. For children insured in the biggest SHI, vaccination coverage estimates based on billing data were compared to estimates considering only continuously insured children since birth, based on additional data provided by this SHI.ResultsDefinition of an appropriate denominator from the billing data was a major challenge: defining the denominator by any consultation by children with different ID numbers yielded 196,732 children, exceeding the number of births in Bavaria by a factor of 1.4. The main causes for this inflated denominator were migration and change of health insurance number. A reduced dataset based on at least one physician's visit in the first six months and 2nd year of life yielded 111,977 children. Vaccination coverage estimates for children in the biggest SHI were at maximum 1.7% higher than in the data set based on continuously insured children.ConclusionWith appropriate adjustments to define the denominator physician's billing data provide a promising tool to estimate immunisation coverage. A slight overestimation based on these data was explained by children never seeing a physician.
Highlights
The introduction of new vaccines for young children requires instruments for a rapid and timely assessment of the progressively increasing vaccination coverage
The inflated denominator can be explained by (1) children migrating to Bavaria or consulting a Bavarian physician in their holidays and (2) children changing health insurance companies; these children will be recorded more than once because of changing insurance numbers
In order to deal with this problem, we reduced the original KVB dataset
Summary
The introduction of new vaccines for young children requires instruments for a rapid and timely assessment of the progressively increasing vaccination coverage. Despite the undoubted usefulness of these data in the absence of better sources, they have several limitations: surveys are fraught with problems regarding completeness, sample size, representativity and immense costs, and school health examinations lag 5 to 6 years behind the current vaccination practice and do not assess types of vaccines or timing of vaccinations. In countries like Germany, France and the US, childhood immunisations are mainly given by the private sector (paediatricians and general practitioners) [4,9]. These physicians get paid for vaccinating, imbursement data related to vaccination have not been used to assess vaccination coverage in a systematic manner
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