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Vaccination Numbers Slip Amid Broader Improvements in Care Quality Vaccination Numbers Slip Amid Broader Improvements in Care Quality

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Vaccination Numbers Slip Amid Broader Improvements in Care Quality

Parents' worries about a link between autism and vaccines are driving down childhood vaccination rates, despite study after study disproving such a connection, according to a report published Thursday.

The study of health care quality measures around the country by the nonprofit National Committee for Quality Assurance found that, overall, patients with health insurance are getting more appropriate care than they have in past years. But there were a few exceptions.


In addition to the two-year slide in childhood immunization rates -- particularly for the measles, mumps, and rubella vaccinations -- the study also found that doctors are continuing to prescribe antibiotics for bronchitis, even though they don't work and despite fears that their use drives the development of drug-resistant superbugs.

But the study found that insurers and providers are doing a better job of screening for colorectal cancers as well as with diabetes management and care related to preventing heart disease.

NCQA's report measured the rates of children at age 2 who had received the recommended slate of immunizations. Those numbers had been steadily climbing for years, but they dipped slightly two years ago.


The new report shows some rebound, but found rates still below 2008 levels. 

For the MMR vaccine, 93.5 percent of 2-year-olds enrolled in HMOs got at least one dose of the vaccine in 2008. Last year, that number dropped to 90.6 percent, and it held about steady at 90.8 percent this year.

This jibes with what the U.S. Centers for Disease Control and Prevention found in 2009 in a survey that showed as many as 40 percent of parents of 2- and 3-year-olds had either delayed or refused one more more vaccines. And researchers reported earlier this month that 10 percent of parents were either refusing or postponing at least one recommended vaccine.

widespread concern about the (disproven) potential for some immunizations to lead to autism; 
other explanations were the rise in cost sharing and the economic downturn.

"Reasons for the drop include widespread concern about the (disproven) potential for some immunizations to lead to autism; other explanations were the rise in cost sharing and the economic downturn," according to the report.


Regarding bronchitis, data show that about 90 percent of cases of the persistent coughs are caused by viruses. But doctors are still prescribing antibiotics more than 60 percent of the time, the report found.

This costs $1.1 billion in wasted dollars, the report points out. 

"Treating drug-resistant pathogens poses a significant burden on the system through repeated health care visits ans greater risk of disease complications and hospitalizations -- which lead to increased health care costs," it says.

As health care costs rise, the NCQA argues that improvements to the quality of care are important both because they help patients get better faster and because they save money.

“It is important to grasp that the most insidious cost problems are often problems of quality -- extra costs resulting from preventable medical errors, overtreatment, and ineffective care,” Margaret O’Kane, the president of the organization, wrote in a preface to the report.

The study found that quality measures varied by location and by type of insurance plan. HMO-style plans tended to have the strongest numbers, while Medicaid plans improved the least.

For instance, colon cancer screening rates went up the most for patients enrolled in HMOs.  In 2003, 49 percent of patients ages 49 to 75 got one of the screening tests that are recommended, such as a colonoscopy or a fecal occult blood test. This went up to nearly 63 percent by 2010.

Preferred provider organizations or PPOs did not do nearly as well -- 43 percent of PPO patients got the recommended conolocopy screening in 2003 and this rose to just 47.6 percent by 2010.

"With some exceptions, commercial HMO performance is typically higher than PPO performance," the report reads. "One reason may be that HMOs have traditionally had more tools to manage care."

The study examined data from 1,000 health plans around the country, representing about 40 percent of the U.S. population. It says health care reform can help if it brings in health insurance exchanges where consumers can choose plans -- if they have the data on quality to make informed choices.

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