Americans willing to pay more for greater vaccine coverage

How much is it worth to you and your family to have a health insurance plan that covers the latest innovations in adult and childhood vaccines for certain types of cancer or even influenza and pneumonia?

A new national web-based study from the University of Michigan Health System found that about 80 percent of adults would be willing to pay an additional $3 to $6 each month in health plan premiums to have their health insurance automatically cover newly recommended vaccines.

The results of the study, the first to indicate broad public preference for coverage of all recommended childhood and adult vaccines in employer-sponsored health plans, are published in the May/June 2005 issue of Health Affairs.

Since the cost of newly approved vaccines has been on the rise during the past few years, some health insurance plans have been resistant to cover them. This trend has left about 15 percent of privately insured children (about 5 million) and as many as 30 percent of privately insured adults (about 36 million) underinsured for new vaccines, and may contribute to immunization rates that fall short of national goals for widely recommended immunizations

With new vaccines on the horizon that will offer innovative tools to prevent infection and certain types of cancer, it is time to look toward a change in health insurance plans, says lead author Matthew Davis, M.D., M.A.P.P, an assistant professor of pediatrics, internal medicine and public policy in the Child Health Evaluation and Research (CHEAR) Unit in the U-M Health System's Division of General Pediatrics.

"Unless we start to think about paying for vaccines in a new way, vaccines of the future may be available to people only if they pay out-of-pocket, and that's not a workable solution for everyone," says Davis. "But this study shows that by paying a little extra in health insurance premiums today, more people will have insurance coverage in the future for new vaccines as soon as they're approved. It's an inexpensive option for most individuals and families, yet is enough to cover the costs of the new vaccines."

For the study, Davis and his colleagues surveyed a group of 995 adults in the United States online to determine their willingness to bear slightly higher plan premiums that would cover recommended vaccines.

As part of the study, participants were asked to consider a situation in which they were employed and offered a health plan as a benefit, which would be the only source of health insurance coverage for them and their families. Plan premiums were $45 per month for individuals and $179 per month for families, and study participants also could opt for no coverage.

Among participants without minor children, 27 percent selected individual coverage and 69 percent chose family coverage. Of those with minors in the household, 11 percent chose individual coverage and 80 percent opted for family coverage.

Participants who selected either individual or family coverage were then asked to select one of two health plans: a plan that covers existing childhood and adult vaccines (basic vaccine coverage) or another that would cover existing vaccines as well as newly recommended vaccines at $3 to $6 more per month (comprehensive vaccine coverage).

Once participants selected a plan, they randomly received either "private gain" or "public good" information that detailed the potential health and economic benefits of vaccines. For example, one set of information advised that new vaccines could cost $75 or more for each dose out-of-pocket without insurance coverage, and that vaccines could reduce medical costs by reducing the need for antibiotics, and physician or emergency department visits, says Davis. Participants were then asked again to choose their preferred level of vaccine coverage.

Overall, about four of out five study participants said they would be willing to bear a minimally higher premium cost (about $3 to $6) each month to guarantee coverage of newly recommended vaccines.

Of those with minors in their household, the majority (77.5 percent) said they would prefer plans with comprehensive coverage for newly recommended childhood vaccines, alone or in combination with comprehensive adult coverage.

For those who opted for no insurance coverage or only basic vaccine coverage, about 25 percent said they would be willing to pay more than $50 for newly recommended vaccines for their children, whereas nearly half of this group said they would not pay for newly recommended vaccines for adults. Those unwilling to pay for adult coverage also were more likely to report an annual income of less than $40,000, compared to those who were willing to pay extra.

Surprisingly, Davis says, consumer information about "private gain" and "public good" did not play a significant role in participants' decision-making process. However, participants who selected comprehensive versus basic coverage were more likely to strongly agree with information that indicated that childhood and adult vaccines are effective, and that vaccines are safe in general.

"This study shows a strong interest of the public in new vaccines, and suggests innovative ways to structure health insurance plans so that the public can benefit from new vaccines in the future," says Davis. "Policymakers, physicians and public health officials need to examine enrollees' preferences as they consider remedies for vaccine underinsurance."

In addition to Davis, the study was co-authored by Kathryn E. Fant, MPH, with the CHEAR Unit in the Division of General Pediatrics at the U-M Health System.