Policy implications of first-dollar coverage: A qualitative examination from the payer perspective

Emily F. Shortridge, Jonathan R. Moorea, Heidi Whitmore, Michael J. O'Grady, Angela K. Shen

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Objectives. Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practicesrecommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates. Methods. This was a qualitative study, using a literature review and semistructured expert interviews with payers. Results. Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons. Conclusions. We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders.

Original languageEnglish (US)
Pages (from-to)394-399
Number of pages6
JournalPublic health reports
Issue number3
StatePublished - 2011
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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