Contrary to expectation, the implementation of Medicaid managed care in New Mexico in the 1990s was associated with significantly decreased immunization coverage for basic childhood vaccination series. An article by University of New Mexico (UNM) researchers, "Immunization Coverage and Medicaid Managed Care in New Mexic A Multimethod Assessment published in the February issue of Annals of Family Medicine, used innovated research techniques to examine the root causes behind that decline.
According to data from the National Immunization Survey, following the policy change, vaccination rates fell from 80 percent in 1996 to 73 percent in 2001, among the lowest in the nation, said Howard Waitzkin, M.D., Ph.D., corresponding author for the study and professor within the UNM School of Medicine Department of Family and Community Medicine. That reduction of eight to ten percent each year translated into 3,000-4,000 additional children who did not receive immunizations in a given year. Estimates for 2002 indicated that New Mexico ranked next to the lowest among states in immunization rates.
The researchers combined statistical analysis with interviews of healthcare providers, patients, families and community activists throughout the state. The combination of quantitative and qualitative research methods used in the research "allow the investigator to address practice and policy issues from the point of view of both numbers and narratives; they add rigor," according to an editorial analyzing the UNM research that appeared in the same issue of the journal.
Although the researchers could not fully determine the causal impact of Medicaid managed care, their findings suggest that the new policy played a significant role in initiating complex systems-level changes associated with declining immunizations. The study findings point to a number of conditions that might have contributed to the decreased immunization coverage:
· a reduction in funding to state-run public health clinics where many of the most vulnerable patients received their care, and difficulty gaining access to Medicaid managed care providers;
· increased informal referrals by private physicians and managed care organizations to community health centers and state-run public health clinics; and
· increased workloads and delays at community health centers linked partly to the informal referrals for immunizations.
Based on New Mexico's experience with Medicaid managed care, the authors caution policy makers about the unanticipated and adverse consequences that seemingly narrow policy changes can have on complex systems. They advise policy makers to consider the direct and indirect effects of Medicaid reform on safety net institutions responsible for immunizations and other necessary preventive services.
UNM Health Sciences Center Vice President R. Philip Eaton pointed out that the study "describes a snapshot in time that precedes the current state of immunizations in New Mexico.
"Last Fall, the University of New Mexico Health Sciences Center joined forces with the Office Of the First Lady of New Mexico and the New Mexico Department of Health to support the efforts of the New Mexico Immunization Coalition (NMIC)," he said. The NMIC was formed in December 2002 and includes many public and private partners, including clinicians, Salud providers, medical societies, school nurses, social service agencies, child care agencies, advocacy agencies, pharmaceutical companies, service clubs, local immunization coalitions and many state agencies.
"First Lady Barbara Richardson has taken on immunizations as one of her priority areas and serves as the honorary co-chair for the statewide coalition," said Eaton. "The NMIC is working to rapidly to improve New Mexico's immunization rates. With the participation of so many agencies and individuals, and the backing of decision makers, we expect to make great strides in protecting New Mexico's children over the next few years."
Contact: Cindy Foster, 272-3322