I get a lot of emails from people who wonder if doctors have any sort of financial incentive to get their patients vaccinated. Do we get any sort of bonus from the insurance companies that pay us? I’ve always thought that the answer to this question was no. I recently found out otherwise.
Now, if you count the fact that part of the income for a doctor’s office comes from providing vaccines themselves, and the checkups that go along with the vaccines, you could argue that that’s a financial incentive. Yes, doctors’ offices do make a little money on vaccines. But I don’t really count that as an actual incentive to try to talk any patients into getting vaccines or as a reason to kick a patient out of a practice if they don’t vaccinate. I don’t think any doctor would kick someone out just because the doctor isn’t going to be able to make as much money on an individual patient who doesn’t get vaccines.
But I recently talked with three physicians in different states that told me the HMO plans that they contract with do chart reviews and patient surveys at the end of each year. If their office scores high enough on these reviews, the HMO plan gives them a several thousand dollar bonus. This bonus varies depending on the number of patients the doctor sees. One of the requirements for a patient’s chart to pass the test is that they are fully vaccinated. In addition, some PPOs now pressure doctors in two additional ways: 1. Some PPOs now won’t cover vaccines unless they are given on the precise CDC schedule, and 2. some PPOs now won’t give doctors premier status on their contracts if they provide vaccines to patients outside of the CDC schedule.
Now, I can somewhat understand the logic behind this. The insurance wants to make sure all their clients are fully vaccinated so they don’t catch any particularly severe disease that might result in an expensive hospitalization or disability that would cost the insurance company a lot of money. Oh, and they probably also care about their clients overall health and wellbeing too. So, why not give their doctors a bonus for meeting this goal?
But such incentives do end up forcing a doctor to consider the financial implications of accepting patients who even just want to opt out of one vaccine. This policy gives any doctor who contracts with such HMO plans an incentive to NOT want any unvaccinating families in their practice. Maybe a few such families wouldn’t make them fail the chart reviews, but if they have too many, there goes their year-end bonus. One colleague here in southern California told me that he happily gives up this bonus because he wants to serve these families. Good for him! But I bet that many doctor across the U.S. refuse care to these families solely because they don’t want to lose this bonus. They make so little from the HMO plan as it is that losing this bonus could make them actually lose money caring for these families.
This also takes some objectivity away from the doctor/patient discussion on the pros and cons of vaccines, and adds some financial bias. Because now the doctor isn’t just trying to convince a patient that vaccines are safe and should be done, the doctor also may be influenced, even subconsciously, by the thought that “if this patient doesn’t vaccinate, I may need to ask them to leave my practice or risk losing money.” Such financial factors should NEVER be part of any informed consent discussion, but sadly, it now is.
I’ve always wondered by so many doctors are so adamantly hardcore about demanding all their patients fully vaccinate, and why they kick patients out of their office who refuse. I’d always just assumed it was because the doctors felt that the vaccine protection was so important that they don’t want any children to be at risk, so they draw a line in the sand for the good of the child (in their minds). BUT some doctors, especially those large groups who rely heavily on large HMO contracts, may actually be doing this because of money. Do they have the right to do so? Of course. But is it right? I don’t know. The American Academy of Pediatrics Committee on Bioethics makes it very clear that the official AAP policy is that doctors NOT kick patients out of their office over this issue. But when money talks, some people don’t listen.
So, knowing this information doesn’t really help parents one way or another. But I thought you’d find it interesting to know why you might be having a hard time finding a vaccine-friendly doctor.