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Background In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE. Objective The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade. Research design Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data. Measures National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability. Results DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability. Conclusions The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.

Objective Given the growth in national disability-associated health care expenditures (DAHE) and the changes in health insurance–specific DAHE distribution, updated estimates of state-level DAHE are needed. The objective of this study was to update state-level estimates of DAHE. Methods We combined data from the 2013-2015 Medical Expenditure Panel Survey, 2013-2015 Behavioral Risk Factor Surveillance System, and 2014 National Health Expenditure Accounts to calculate state-level DAHE for US adults in total, per adult, and per (adult) person with disability (PWD). We adjusted expenditures to 2017 prices and assessed changes in DAHE from 2003 to 2015. Results In 2015, DAHE were $868 billion nationally (range, $1.4 billion in Wyoming to $102.8 billion in California) accounting for 36% of total health care expenditures (range, 29%-41%). From 2003 to 2015, total DAHE increased by 65% (range, 35%-125%). In 2015, DAHE per PWD were highest in the District of Columbia ($27 839) and lowest in Alabama ($12 603). From 2003 to 2015, per-PWD DAHE increased by 13% (range, −20% to 61%) and per-capita DAHE increased by 28% (range, 7%-84%). In 2015, Medicare DAHE per PWD ranged from $10 067 in Alaska to $18 768 in New Jersey. Medicaid DAHE per PWD ranged from $9825 in Nevada to $43 365 in the District of Columbia. Nonpublic–health insurer per-PWD DAHE ranged from $7641 in Arkansas to $18 796 in Alaska. Conclusion DAHE are substantial and vary by state. The public sector largely supports the health care costs of people with disabilities. State policy makers and other stakeholders can use these results to inform the development of public health programs that support and provide ongoing health care to people with disabilities.

Vaccinations are recommended to prevent serious morbidity and mortality. However, providers' concerns regarding costs and payments for providing vaccination services are commonly reported barriers to adult vaccination. Information on the costs of providing vaccination is limited, especially for adults.We recruited 4 internal medicine, 4 family medicine, 2 pediatric, 2 obstetrics and gynecology (OBGYN) practices, and 2 community health clinics in North Carolina to participate in a study to assess the economic costs and benefits of providing vaccination services for adults and children. We conducted a time-motion assessment of vaccination-related activities in the provider office and a survey to providers on vaccine management costs. We estimated mean cost per vaccination, minimum and maximum payments received, and income.Across all provider settings, mean cost per vaccine administration was $14 with substantial variation by practice setting (pediatric: $10; community health clinics: $15; family medicine: $17; OBGYN: $23; internal medicine: $23). When receiving the maximum payment, all provider settings had positive income for vaccination services. When receiving the minimum reported payments for vaccination services, pediatric and family medicine practices had positive income, internal medicine, and OBGYN practices had approximately equal costs and payments, and community health clinics had losses or negative income.Overall, vaccination service providers appeared to have small positive income from vaccination services. In some cases, providers experienced negative income, which underscores the need for providers and policymakers to design interventions and system improvements to make vaccination services financially sustainable for all provider types.

INTRODUCTION: Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how costs compared with payments for adult vaccinations in a sample of U.S. physician practices. METHODS: We recruited a convenience sample of 19 practices in nine states. We collected data on the time and material costs of the vaccination work flow using a management survey and a time-motion study. We collected data on payments received for vaccine doses and vaccine administration for different payer types using a finance survey. We received complete cost and payment data from 13 of the 19 practices. We compared payments for vaccines to prices paid for vaccines. We calculated annual net revenue from vaccination services by combining payments received for vaccine doses and vaccine administration with estimated costs. RESULTS: The extent to which vaccine payments exceeded vaccine prices varied by payer type, with per-dose payments from Medicare exceeding prices paid for 5 out of 5 vaccines , from Medicaid for 9 out of 14 vaccines, and from private health plans for 16 out of 21 vaccines. The median annual total net revenue from vaccination services was $90,343 at family medicine practices (range: $3,968 to $249,628), $28,267 at internal medicine practices (−$32,659 to $141,034) and $2,886 at obstetrics and gynecology practices (−$73,451 to $23,820). CONCLUSIONS: Payments received generally exceeded prices paid for most vaccines. Adult vaccination was profitable at the median of our sample, but there is wide variation in profitability due to differences in costs and payment rates across practices. This study provides evidence on the economic viability of adult vaccination that can help inform practices’ decisions whether to provide adult vaccines and contribute to keeping adults up-to-date with the recommended vaccination schedule.

Amid provider reports of financial barriers as an impediment to adult immunization, this study explores the time and costs of vaccination in adult provider practices. Both a Vaccination Time-Motion Study and Vaccine Practice Management Survey were conducted (March – October 2017) in a convenience sample of 19 family medicine (FM), internal medicine (IM), and obstetrician-gynecology (OBGYN) practices, in nine states. Practices were directly observed during a one week period; estimates were collected of time spent on activities that could not be directly observed. Cost estimates were calculated by converting staff time for performed activities. In the time-motion study, FM and IM practices spent similar time conducting vaccination activities (median = 5 min per vaccination), while OBGYN practices spent more time (median = 29 min per vaccination). Combining results from the time-motion study and the practice management survey, the median costs of vaccination remained similar for FM practices and IM practices at $7 and $8 per vaccination, respectively, but was substantially higher for OBGYN practices at $43 per vaccination. Factors that contributed to higher costs among OBGYN practices were the increased time to counsel patients, administer vaccines, and to plan and manage vaccine supplies. In addition, 68% of OBGYN patients who were offered and counseled to receive vaccines declined to receive them. Counseling patients who ultimately do not go on to receive a vaccine may be an important cost factor. Lower costs of vaccination services may be achieved by increasing efficiencies in workflow or the volume of vaccinations.