Original article
School-Located Vaccination of Adolescents With Insurance Billing: Cost, Reimbursement, and Vaccination Outcomes

Prior Presentations: Portions of this work were presented at the Pediatric Academic Societies' Annual Meeting, Boston, MA (2012, April 28).
https://doi.org/10.1016/j.jadohealth.2013.12.011Get rights and content

Abstract

Purpose

To assess, in a school-located adolescent vaccination program that billed health insurance, the program costs, the proportion of costs reimbursed, and the likelihood of vaccination.

Methods

During the 2010–2011 school year, vaccination clinics were held for sixth- to eighth-grade students at seven Denver public schools. Vaccine administration and purchase costs were compared with reimbursement by insurers. Multivariate analyses were used to compare the likelihood of vaccination among students in intervention schools with students in control schools who did not participate in the program, with analyses stratified by grade (sixth grade vs. seventh–eighth grades).

Results

Fifteen percent (466 of 3,144) of students attending intervention schools were vaccinated at school-located vaccination clinics. Among students vaccinated at school, 41% were uninsured, 37% publicly insured, and 22% privately insured. Estimated vaccine administration costs were $23.98 per vaccine dose. Seventy-eight percent of vaccine purchase costs and 14% of vaccine administration costs were reimbursed by insurers; 41% of total program costs were reimbursed. Sixth-grade students in intervention schools were more likely than those in control schools to receive tetanus–diphtheria–acellular pertussis (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.08, 1.57), meningococcal conjugate (RR, 1.42; CI, 1.18, 1.70), and human papillomavirus (for females only, RR, 1.69; CI, 1.21, 2.36) vaccines during the 2010–2011 school year, with similar results for seventh- to eighth-grade students.

Conclusions

Although school-located adolescent vaccination with billing appears feasible and likely to improve vaccination rates, improvements in insurance coverage and reimbursement rates may be needed for the long-term financial sustainability of such programs.

Section snippets

Study setting

This study was conducted during the 2010–2011 school year in the Denver Public Schools, an urban public school district with approximately 74,000 students in kindergarten through high school. The human subjects review boards at the University of Colorado and the school district approved the study; informed consent for study participation was not required.

Study schools

Sixteen Denver public schools were eligible to participate, representing all noncharter sixth- to eighth-grade schools and a random sample of

School characteristics

The characteristics of intervention and control schools are listed in Table 1. The seven intervention schools had a median school enrolment of n = 289 sixth- to eighth-grade students (range, 111–951); the seven control schools had a median enrolment of n = 350 sixth- to eighth-grade students (range, 156–977).

Vaccination program characteristics

During the 2010–2011 school year, the total student body in intervention schools was 3,144; because influenza vaccine was offered, all students were assumed to need at least one vaccine.

Discussion

In a school-located adolescent vaccination program designed to bill for vaccination services provided, we found that privately insured, publicly insured, and uninsured students participated, the program was able to bill for vaccination, and the program increased the likelihood that students received Tdap, MCV4, and HPV vaccines. Overall, 41% of total program costs were reimbursed, with 78% of vaccine purchase costs and 14% of vaccine administration costs recouped through billing. Several

Acknowledgments

This investigation was supported by Cooperative Agreement #U01-1P00016-01 from the Centers for Disease Control and Prevention. The findings and conclusions are solely the responsibility of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This investigation would not have been possible without the strong support of Denver Public Schools personnel, including Donna Shocks, M.S.N., C.N.S., R.N., manager of Nursing and Student

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    Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

    Financial Disclosure: Dr. Daley has received an honorarium from McGraw-Hill publishers for writing a book chapter on immunization.

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