Physician Payments and the Receipt of Human Papillomavirus Vaccine among Privately Insured Adolescents

In 2006, quadrivalent human papillomavirus vaccine (4vHPV) was licensed for use in females and in 2007 the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 4vHPV in females aged 11 or 12 years. The licensure of HPV vaccine for use in males was approved in 2009 and the associated ACIP recommendations was published in 2011. Although HPV vaccines have shown promising results in reducing HPV infections, the uptake of the vaccine has been less than ideal. Financial concerns, such as high vaccine purchase costs and inadequate insurance reimbursements, are commonly cited as one of the key barriers to human papillomavirus (HPV) vaccination among healthcare providers. None of the existing studies has assessed physician payment for providing HPV vaccination services and its potential impact on the uptake of HPV vaccines among adolescents. This study uses the 2013-2014 MarketScan Commercial Claims and Encounters Database (CCAE). The sample includes adolescents 11-17 years continuously enrolled in a non-capitated private insurance plan in each year and excludes those who had received a HPV vaccine prior to each study year. Linear regressions are used to estimate the link between physician payments for a HPV vaccination visit and the probability of adolescents initiating the HPV vaccine series and the probability of adolescents receiving ≥ 2 HPV vaccine doses in the year. The key independent variable is state median payment for a HPV vaccination visit. The payment variable includes all aspects of the provider’s income incurring from providing a HPV vaccination service - insurance reimbursements for the HPV vaccine and vaccine administration and patients’ cost sharing for the visit (deductibles, coinsurance, and copayment). The findings show that physician payments are positively associated with HPV vaccine uptakes. For every $1 increase in payments, the probability of adolescents initiating the HPV vaccine series increased by 0.18 percentage point (an increase of 1.5% from the mean) and the probability of receiving ≥ 2 HPV vaccine doses increased by 0.10 percentage point (an increase of 2.1% from the mean).