Background: Detailed timekeeping for childhood immunization activities in rural practices has not been conducted prior to this study.

Objective: To measure the variable costs (labor and supplies) to rural practices, health centers and health departments of delivering immunizations to children under two.

Methods: Patient care and office staff in 6 private practices, 1 health center site, and 4 health department sites in 4 rural Colorado counties recorded time spent on activities (billing, reminder/recall, vaccine administration, non-routine, and physician time) related to vaccine administration for one month. Salaries and benefits were obtained for all personnel (except physicians). Physician compensation was estimated based on averages for rural Colorado physicians. Supply costs were obtained from the practices. Average practice vaccine cost was estimated using lowest private sector prices from the CDC Vaccine Price List (11/14/97), weighted by the number of each type recommended for children under 2 on the ACIP/AAP/AAFP schedule.

Results: Mean 1997 variable cost of providing immunizations in rural Colorado was:

Public health departments/county nursing services $5.44 /dose (range: $3.86- $8.28)

Private Practices $5.87/dose (range: $4.61 - $7.88)

Community Health Center $6.51/dose

Neither health departments nor community health centers pay for vaccine, while private practices do (except for their VFC patients). The average private sector vaccine cost was $17.02.

Conclusion: Private insurers should consider variable costs and the cost of vaccine, as well as an allowance for overhead, when determining reimbursement rates. Adequate reimbursement of private providers will encourage provision of immunization by the primary care provider.