Vaccine Hesitancy Strains Health Care Cost Containment-Who is Responsible?

Those who chose to protect themselves and their family should not subsidize the care of those who haven’t


Much of the discussion around vaccine hesitancy focuses on the idea of personal choice and personal behavior. But what happens when personal choices, including not to get vaccinated against COVID-19, ends up costing insurance companies and employers hundreds of thousands of dollars? Why shouldn’t that financial cost be put on those seeking treatment who have refused a proven safe and effective means to preventing serious illness and in many cases hospitalization? These are questions the stakeholders in the health care insurance industry must urgently answer.

This question is not a new one, however. Historically, there is a strong correlation between an individual’s environment and the healthcare choices they make, otherwise known as social determinants of health. For example, someone who works two jobs and lives far from a gym may have a hard time staying in physical shape or, someone who lives in a food desert may have limited access to healthy meal options. Examples like these have shifted the industry’s thinking from individual responsibility to systemic factors contributing to health outcomes. Because of this, our interventions are often targeted at entire populations, not individuals. We can think about how the tobacco and alcohol industries have taken measures not to advertise directly to children, understanding that the environment children are exposed to can significantly impact the choices they make.

Globally, we are facing another issue that’s prolonging the COVID-19 pandemic: vaccine misinformation and disinformation. We are aggressively combating this in the United States by developing culturally sensitive programming to reach entire communities with high vaccine hesitancy rates. Part of this work is to acknowledge historical equity issues contributing to people’s decisions around vaccination, and developing interventions to communicate clear, correct information to those populations.

However, if the health care industry is tackling vaccine hesitancy on a systemic level, how can we as insurance providers assign financial responsibility to individuals based on their COVID-19 vaccination status? The answer may be found in both precedence and science.

There is a decades-old precedent in how to address individual choice for a societal issue in healthcare: tobacco use. We frequently use financial levers to influence how we want people to behave while protecting their rights to make choices. For example, smokers can smoke, but we assess taxes on each pack of cigarettes to discourage smoking. Health insurance companies, life insurance companies, and some employers, will put a surcharge on tobacco users, not only to mitigate their own costs, but to also discourage the act all together.

We, as a society, routinely impose financial fines on various behaviors considered dangerous or reckless to others. It would not be unreasonable to assess the same costs on those who are unvaccinated commensurate with the risk and strain they impose on our health care system.

The science provides clear evidence. Similar to smoking, we can clearly identify the independent risk factor currently responsible for increased hospitalizations and the vast majority of COVID-19 deaths: lack of vaccination. While many other health conditions have multi-factorial contributors that are too hard to pinpoint or assess, the vaccine has been shown to reduce hospitalizations and deaths significantly. It is hard to justify sharing the financial risks of COVID-19 across a population when we can clearly identify those who chose to modify their risk, and those who haven’t. Those who have chosen to protect themselves and their family should not subsidize the care of those who haven’t.

As insurance providers, we need to think about what financial instruments we have to encourage vaccinations and limit excessive COVID-19 related healthcare expenditures. Employers who bear financial risk from lost productivity and rising healthcare costs should also start assessing what tools they have to motivate vaccination and limit exposure from COVID-19 related expenses. We should support those who chose to be vaccinated and acknowledge their effort in protecting our health and financial wellbeing.

DR. MORDECHAI PAVLOVSKY joined Sutter Health | Aetna as the Chief Medical Officer and Head of Operations & Innovation in April 2021. In his role, Dr. Pavlovsky develops and leads Sutter Health | Aetna’s overarching strategy and operational plan, as well as ongoing clinical operations. He also is the liaison between Sutter Health, Aetna, and CVS Health® innovation and transformation teams.
Pavlovsky is also an emergency medicine physician at Sutter Health Alta Bates Summit Medical Center (ABSMC). He pursued his master’s degree in business administration to improve his understanding of the healthcare ecosystem and to learn where there are areas of opportunity. Most recently, Dr. Pavlovsky completed his master’s degree in business administration from the University of California, Berkeley Haas School of Business.
Editor’s Note: The views expressed here are solely the author’s. If you have an opinion to share, email