The economics of the flu shot

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
In the hearty debates taking place around McKnight's stories about the flu shot, there's one angle that, quite frankly, hasn't been brought up much.

It's the question of cost.

In all the discussion around who will get a flu shot, the price tag is hardly ever mentioned. This is a profession where people may complain about reimbursement for their facility, or the cost of sending a child to college, but it is harder to find someone who admits it would be a struggle to shell out $120 for a family of four to be vaccinated.

Flu shots are often covered by insurance, and many employers pick up the cost of getting a flu shot. At the newspaper where I worked years ago, the benefits primarily consisted of the occasional day when an editor didn't yell at you. But every year, we lined up in the office to receive our complimentary flu shot. This was not because of corporate compassion, but rather because flu-ridden reporters end up costing more money than providing the vaccinations.

So it's easy to start believing free flu shots are all around us, and the outcome is plenty of pharmacies getting in trouble for marketing them as such. Last year the New York Attorney General settled with Walgreens over this problem, as those covered under the NYS Empire Plan said they were misled into thinking their shots were free.

Why the confusion? Even if you have insurance, the out-of-pocket cost can vary. My sister, smart enough to get her flu shot last summer when she was covered under a temporary self-paid insurance plan, in return received various notices from Walgreens over the past six months saying she owed first $15 and then $12.67. My husband, who is covered under my insurance plan, received a $31 flu shot at Walgreens, and our insurance reimbursed us for half after we sent in the claim. My flu shot, which I got in my physician's office and was billed at a higher cost than Walgreens, was completely free to me.

For many of us, we'll write the check to the pharmacy or forgo the claim for $10, $20 or $30 because a) it might not going to make the difference in which groceries we buy that week b) because it's worth that much to us to not get the flu c) our time is worth enough to not fight with our insurance company or d) all of the above.

The Los Angeles Times ran a piece Monday that looks at the question from the opposite side: Why does a flu shot cost so little? As healthcare providers know, the flu shot has to be updated each year. That means it's a guessing game for manufacturers of how much to produce.

Preventative medicine is a hard concept to embrace, even if you know logically it makes sense. Even if the cost to do this would be less than, say, use birth control rather than getting pregnant, or to get a shot rather than have an illness, it's alluring to many to tempt fate.

There are plenty of people who will decline flu shots, no matter the cost. But if there's a lesson to be learned from this flu season, it's that providing free flu shots to your employees may pay more dividends than having a decimated and ill workforce.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


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