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Vaccines 2017, 5(1), 8;

The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake

Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70118, USA
Department of Health Policy, The George Washington University School of Public Health and Health Services, Washington, DC 20052, USA
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Author to whom correspondence should be addressed.
Academic Editor: Diane M. Harper
Received: 30 November 2016 / Revised: 17 February 2017 / Accepted: 22 February 2017 / Published: 6 March 2017
Full-Text   |   PDF [195 KB, uploaded 6 March 2017]


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. View Full-Text
Keywords: vaccination; Medicaid; influenza vaccination; Medicaid; influenza
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Stoecker, C.; Stewart, A.M.; Lindley, M.C. The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influenza Vaccination Uptake. Vaccines 2017, 5, 8.

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