bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial Burden of Raising CSHCN: Association With State Policy Choices
Authors: Parish Susan L. , Shattuck Paul T. , Rose Roderick A. 
Published: November 2009

OBJECTIVE: We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN).
SAMPLE AND METHODS: Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics.
RESULTS: Overall, 61% of low-income families reported expenditures of &gt;$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden.
CONCLUSIONS: Beyond child and family characteristics, there is considerable state-level variability in low-income families’ out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits.
Variation in Provider Vaccine Purchase Prices and Payer Reimbursement
Authors: Freed Gary L. , Cowan Anne E. , Gregory Sashi , Clark Sarah J. 
Published: November 2009

OBJECTIVE: The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers.
METHODS: We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration.
RESULTS: Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62.
CONCLUSIONS: There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.
Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations
Authors: Freed Gary L. , Cowan Anne E. , Clark Sarah J. 
Published: November 2009

OBJECTIVES: The purpose of this research was to explore physicians' attitudes and behaviors related to vaccine financing issues within their practice. Amid the increasing number of vaccine doses recommended for children and adolescents, anecdotal reports suggest that physicians are facing increasing financial pressures from vaccine purchase and administration and may stop providing vaccines altogether to privately insured children. Whether these sentiments are widely held among immunization providers is unknown.
METHODS: We conducted a cross-sectional mail survey from July to September 2007 of a random sample of 1280 US pediatricians and family physicians engaged in direct patient care. Main outcome measures included delay in the purchase of specific vaccines for financial reasons; reported decrease in profit margin from immunizations; and practice consideration of whether to stop providing all vaccines to privately insured children.
RESULTS: The response rate was 70% for pediatricians and 60% for family physicians. Approximately half of the respondents reported that their practice had delayed the purchase of specific vaccines for financial reasons (49%) and experienced decreased profit margin from immunizations (53%) in the previous 3 years. Twenty-one percent of respondents strongly disagreed that “reimbursement for vaccine purchase is adequate,” and 17% strongly disagreed that “reimbursement for vaccine administration is adequate.” Eleven percent of respondents said their practice had seriously considered whether to stop providing all vaccines to privately insured children in the previous year.
CONCLUSIONS: Physicians who provide vaccines to children and adolescents report dissatisfaction with reimbursement levels and increasing financial strain from immunizations. Although large-scale withdrawal of immunization providers does not seem to be imminent, efforts to address root causes of financial pressures should be undertaken.
Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices
Authors: Coleman Margaret S. , Lindley Megan C. , Ekong John , Rodewald Lance 
Published: November 2009

OBJECTIVE: The goal was to determine the net return (gain or loss after costs were subtracted from revenues) to private pediatric medical practices from investing time and resources in vaccines and vaccination of their patients.METHODS: A cross-sectional survey of a convenience sample of private medical practices requested data on all financial and capacity aspects of the practices, including operating expenses; labor composition and wages/salaries; private- and public-purchase vaccine orders and inventories; Medicaid and private insurance reimbursements; patient population; numbers of providers; and numbers, types, and lengths of visits. Costs were assigned to vaccination visits and subtracted from reimbursements from public- and private-pay sources to determine net financial gains/losses from vaccination.RESULTS: Thirty-four practices responded to the survey. More than one half of the respondents broke even or suffered financial losses from vaccinating patients. With greater proportions of Medicaid-enrolled patients served, greater financial loss was noted. On average, private insurance vaccine administration reimbursements did not cover administration costs unless a child received ≥3 doses of vaccine in 1 visit. Finally, wide ranges of per-dose prices paid and reimbursements received for vaccines indicated that some practices might be losing money in purchasing and delivering vaccines for private-pay patients if they pay high purchase prices but receive low reimbursements.CONCLUSIONS: We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.
Cost of Vaccine Administration Among Pediatric Practices
Authors: Glazner Judith E. , Beaty Brenda , Berman Stephen 
Published: November 2009

OBJECTIVE: The goal was to describe variable costs to providers of delivering childhood immunizations.METHODS: We documented variable costs (costs that vary with the amount of services rendered), including time spent by pediatric staff members and physicians on immunization-related activities, as well as supply costs and medical waste disposal costs. Ten private pediatric practices in the Denver, Colorado, metropolitan area participated in the study. Among the 7 practices that provided us with payment data, 8 health plans were mentioned by ≥2 practices. There were 37 different agreements between the health plans and practices for vaccine administration payments.RESULTS: The total documented variable cost per injection (excluding vaccine cost) averaged $11.51, calculated from the following categories: nursing time, $1.71; billing services, $2.67; nonroutine services, $1.64; registry use, $0.96; physician time, $4.05; supplies, $0.36; medical waste disposal, $0.12. Nonroutine activities primarily included performing vaccine inventory and ordering, providing vaccination records to requesters, and answering parent telephone questions about vaccinations. With the use of a simulation model to compensate for the small number of participating practices, the calculated total variable cost per injection was $11.83. When 2 vaccines were administered, we compared the sum of the 2 payments with the sum of the 2 variable costs ($23.02). More than one third of the payment agreements (13 of 37 agreements) paid the practices less than the combined variable costs for 2 immunizations.CONCLUSION: This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and health plans.
Health Insurance Plans and Immunization: Assessment of Practices and Policies, 2005–2008
Authors: Hunsaker John , Veselovskiy German , Gazmararian Julie A. 
Published: November 2009

OBJECTIVES: The goals were to assess private health insurance plans' policies and practices regarding recommended immunizations in 2008 and to identify trends since the America's Health Insurance Plans (AHIP) 2005 Immunization Assessment.
METHODS: In May 2008, AHIP staff members e-mailed a survey containing 46 questions on immunization practices to 101 AHIP member private health insurance plans. Of those, 58 responded (representing 121345521 covered individuals) and 43 declined to participate, yielding a response rate of 57% (compared with 53% in 2005). Data are reported as proportions of enrollees (weighted data) or of responding plans (unweighted data).
RESULTS: In 2008, almost all enrollees (99.8%) represented in the survey were in health insurance plans that used Advisory Committee on Immunization Practices (ACIP) recommendations to determine coverage. The vast majority (≥99.0%) of enrollees were in plans covering all ACIP-recommended child and adolescent vaccines in ≥75% of the health insurance product lines offered, and ≥16.5% of enrollees were in plans covering these vaccines in all products. The majority of enrollees (≥83.3%) were in plans covering ACIP-recommended pediatric and adolescent vaccines without cost-sharing. Plans covering 95.5% of enrollees updated benefits to reflect changes in vaccine recommendations within ≤3 months, compared with 60.0% in 2005. In 2008, 96.7% of enrollees were in plans that could reimburse providers for vaccines within 3 months once the vaccines were included in benefit designs, compared with 59.2% in 2005.
CONCLUSION: The survey shows widespread private health insurance plan coverage of vaccines, consistent with, or better than, the coverage levels reported in the AHIP 2005 survey.
Perspective of Vaccine Manufacturers on Financing Pediatric and Adolescent Vaccines in the United States
Authors: Shen Angela K. , Rodewald Lance E. , Birkhead Guthrie S. 
Published: November 2009

OBJECTIVE: The goal was to understand vaccine manufacturers' perspectives on vaccine financing as a barrier to immunization.
METHODS: Individual telephone interviews with representatives of the 6 manufacturers that produce routinely recommended vaccines for children and adolescents in the United States were conducted in November and December 2006.
RESULTS: Although manufacturers acknowledged that the price of newer vaccines presents challenges to optimal vaccine use, they asserted that children and adolescents have access to vaccinations through public and private insurance. Respondents suggested that the system could be improved through adequate funding of the public-sector safety net. Respondents stated that providers should receive timely reimbursement for the full costs of vaccine purchase and administration, and manufacturers who sell directly to health care providers may provide flexible payment terms for vaccine purchases. Manufacturers supported targeted expansion of the Vaccines for Children program to allow children with incomplete insurance coverage for vaccines to receive vaccines at health department clinics. Manufacturers perceived delays in publication of Advisory Committee on Immunization Practices recommendations as a potential barrier to vaccine uptake. They viewed the perceived lack of public value for vaccines as a potential barrier to adequate reimbursement and optimal utilization. Respondents also maintained that their ability to negotiate vaccine prices through the private market is a crucial priority.
CONCLUSIONS: Manufacturers assert that children and adolescents have access to immunizations through public and private insurance. Manufacturers think that they have mitigated the challenge most directly in their control: the large financial outlays required for up-front vaccine purchases.
Pediatrician-Family-Patient Relationships: Managing the Boundaries
Authors:   Committee on Bioethics
Published: November 2009

This Policy Statement was reaffirmed January 2014 and October 2020.
All professionals are concerned about maintaining the appropriate limits in their relationships with those they serve. Pediatricians should be aware that, under normal circumstances, caring for one's own children presents significant ethical issues. Pediatricians also must strive to maintain appropriate professional boundaries in their relationships with the family members of their patients. Pediatricians should avoid behavior that patients and parents might misunderstand as having sexual or inappropriate social meaning. Romantic and sexual involvement between physicians and patients is unacceptable. The acceptance of gifts or nonmonetary compensation for medical services has the potential to affect the professional relationship adversely.
Supplemental Security Income (SSI) for Children and Youth With Disabilities
Authors:   Council on Children With Disabilities
Published: November 2009

This Policy Statement was reaffirmed February 2015 and August 2021.
The Supplemental Security Income (SSI) program remains an important source of financial support for low-income families of children with special health care needs and disabling conditions. In most states, SSI eligibility also qualifies children for the state Medicaid program, providing access to health care services. The Social Security Administration (SSA), which administers the SSI program, considers a child disabled under SSI if there is a medically determinable physical or mental impairment or combination of impairments that results in marked and severe functional limitations. The impairment(s) must be expected to result in death or have lasted or be expected to last for a continuous period of at least 12 months. The income and assets of families of children with disabilities are also considered when determining financial eligibility. When an individual with a disability becomes an adult at 18 years of age, the SSA considers only the individual's income and assets. The SSA considers an adult to be disabled if there is a medically determinable impairment (or combination of impairments) that prevents substantial gainful activity for at least 12 continuous months. SSI benefits are important for youth with chronic conditions who are transitioning to adulthood. The purpose of this statement is to provide updated information about the SSI medical and financial eligibility criteria and the disability-determination process. This statement also discusses how pediatricians can help children and youth when they apply for SSI benefits.
The Effects of Chilean Coho Salmon and Rainbow Trout Aquaculture on Markets for Alaskan Sockeye Salmon
Authors: Williams Abby , Herrmann Mark , Criddle Keith R. 
Published: November 2009

Abstract
A simultaneous-equation equilibrium model of international salmonid markets is used to examine the combined effect of variability in the landings of Alaska's sockeye salmon Oncorhynchus nerka and increases in the production of Chile's Atlantic salmon Salmo salar, coho salmon O. kisutch, and rainbow trout O. mykiss on Alaska's sockeye salmon exvessel prices and revenues. While Atlantic salmon, coho salmon, and rainbow trout from Chile and sockeye salmon from Alaska are not identical commodities, they compete in many of the same domestic and international markets, and Alaska's earnings in those markets have declined as Chile's production has increased. Although Alaska's average annual harvests have remained nearly constant, Alaska's production is now a small percentage of the total salmonid production in a world that eats significantly more salmonids than it did 25 years ago. Nevertheless, our model indicates that sockeye salmon prices continue to be sensitive to interannual variations in the quantity of sockeye salmon harvested in Alaska and to changes in the quantity of Atlantic salmon, coho salmon, and rainbow trout produced in Chile. However, the model indicates that exvessel revenues are less sensitive than exvessel prices and that Alaska's recent levels of sockeye salmon landings have been near the maximum of the total exvessel revenue curve. In addition, the model suggests that because Alaska's share of the production of high-value salmon (Chinook, coho, and sockeye salmon) has declined, exvessel prices for sockeye salmon are now less sensitive to changes in Chilean production of Atlantic salmon, coho salmon, and marine-reared rainbow trout. The implication of these findings is that, under current market conditions, exvessel revenues from Alaska's sockeye salmon fisheries can be maximized by maintaining catches at or near historic levels and that exvessel prices are unlikely to continue to decline as rapidly as they did in the 1990s.
Potential Sources of Survey Bias Associated with Hand-Retrieved Longline Catches of Subadult Sharks in Georgia Estuaries
Authors: Belcher Carolyn N. , Jennings Cecil A. 
Published: November 2009

Abstract
Lunar phase, tide stage, and bait type were examined as potential sources of survey bias affecting catch rates of subadult sharks on hand-retrieved longlines in Georgia estuaries. Sampling occurred during April–September from 2001 to 2003 in eight of Georgia's nine estuaries; this sampling period coincides with the pupping seasons for a variety of shark species. The effects of lunar phase and tide stage on catch rates of sharks were evaluated during 2001 and 2002. The effect of bait type (i.e., squid Loligo spp. or spot Leiostomus xanthurus) on shark catch rates was evaluated during 2003. During 2001 and 2002, 420 subadult sharks representing two families (Carcharhinidae and Sphyrnidae) and nine species were caught during 212 longline sets. Catch rates were evaluated for the four most commonly occurring shark species: the Atlantic sharpnose shark Rhizoprionodon terraenovae, bonnethead Sphyrna tiburo, blacktip shark Carcharhinus limbatus, and sandbar shark C. plumbeus. Neither lunar phase nor tide stage affected catch rates of any species other than blacktip sharks. In 2003, longline sets (n = 80) resulted in the capture of 177 subadult sharks from seven species. Overall catch rates were higher with squid bait than with spot, and bait type also affected shark species catch composition. Mean sizes of Atlantic sharpnose sharks were significantly different between the two bait types, indicating a possible ontogenetic shift in bait preference. For example, catch of neonate Atlantic sharpnose sharks was higher on hooks baited with squid than on hooks baited with spot, whereas catch of juveniles was higher on hooks baited with spot. Although timing of sampling events did not influence catch rates of subadult sharks, bait choice could bias estimates of abundance for certain life stages and affect the probability of detecting some species.
Microsatellite Stock Identification of Chum Salmon on a Pacific Rim Basis
Authors: Beacham Terry D. , Candy John R. , Wallace C. , Urawa Shigehiko , Sato Shunpei , Varnavskaya Natalia V. , Le Khai D. , Wetklo Michael 
Published: November 2009

Abstract
The variation at 14 microsatellite loci was analyzed for more than 53,000 chum salmon Oncorhynchus keta from 381 locations ranging from Korea to Washington State and used to estimate the stock composition of mixed-stock fishery samples. High resolution of the samples was possible, the number of reporting groups being distributed as follows: Korea = 1, Japan = 7, Russia = 8, Alaska = 15, Canadian Yukon River = 5, British Columbia = 16, and Washington State = 5. The number of alleles observed at a locus was related to the power of the locus in providing accurate estimates of the stock composition of single population mixtures. Approximately 800 alleles were observed across the 14 microsatellites, providing the basis for high-resolution stock identification. Analysis of known-origin samples indicated that accurate regional estimates of stock composition were obtained. The estimated stock compositions of mixed-fishery samples from coastal Japan, the Sea of Okhotsk, the western Pacific Ocean, the Gulf of Alaska, and coastal British Columbia were quite different among samples and clearly reflected the presence of local populations. Microsatellites have provided the ability to obtain accurate estimates of the stock composition of chum salmon from many locations in the Pacific Rim.