Insurance-based compensation for adverse reactions following immunization in Wuxi City, Jiangsu Province from 2020 to 2022

Abstract

ObjectiveTo assess the implementation of insurance-based compensation for adverse reactions following immunization in Wuxi City,Jiangsu Province.MethodsData on basic insurance and supplementary insurance for adverse reactions following immunization from 2020 to 2022 in Wuxi City was collected, and a descriptive epidemiological method was used to analyze the data.ResultsA total of 2 272 cases were compensated for adverse reactions following immunization,with a total compensation amount of 5.255 9 million yuan, and an average of 2.3 thousand yuan per case. Basic insurance accounted for 0.62% of the total cases and 10.72% of the total compensation amount, while supplementary insurance accounted for 99.43% of the total cases and 89.28% of the total compensation amount. Compensation amounts for disability and third-degree damage in basic insurance accounted for 63.18% and 88.71%, respectively, while fourth-degree and lower damage in supplementary insurance accounted for 96.52%. The compensation rate for supplementary insurance was higher than that for basic insurance. The highest number of compensated cases was in the 0‒ year age group, and vaccines included in the Expanded Program on Immunization (EPI) accounted for the majority of the cases and compensation amounts, with a percentage of 70.11% and 73.84%, respectively. For basic insurance, the largest number of compensated cases involved the Bacillus Calmette-Guérin (BCG) vaccine. For supplementary insurance, the top three compensated cases for EPI vaccines were the measles-mumps-rubella (MMR) vaccine, the hepatitis B (HepB) vaccine, and the acellular diphtheria-tetanus-pertussis (DTaP) vaccine. For non-EPI vaccines, the top three compensated cases were the 13 valent pneumococcal polysaccharide conjugate (PPCV13) vaccine, the acellular DPT-inactivated poliovirus-haemophilus influenzae type b combined vaccine (DPT-IPV/Hib), and enterovirus 71 (EV71) inactivated vaccine. In basic insurance, thrombocytopenic purpura and BCG local abscess both accounted for 21.43% of the cases, while in supplementary insurance, respiratory system diseases accounted for 77.47% of the cases. The time intervals from reporting to submission of compensation materials (<31 d) and from submission to payment of compensation (≤14 d) were 71.43% and 57.14% for basic insurance, and 90.22% and 86.23% for supplementary insurance, respectively.ConclusionThe commercial supplementary insurance for adverse reactions following immunization in Wuxi City has largely compensated for the limitations of basic insurance in terms of coverage and efficiency. It is recommended to further promote commercial compensation insurance for young children and strengthen the monitoring and regulation of commercial supplementary insurance compensation.

Keywords

• vaccine
• adverse reactions following immunization
• basic insurance
• supplementary insurance
• compensation