美国医疗保险和医疗补助服务中心（CMS）取消了联邦层面将医生诊疗费与医疗补助计划（Medicaid）和儿童健康保险计划（CHIP）中的儿童疫苗接种率挂钩。
在医疗保健政策和医学伦理方面取得重大进展，美国医疗保险和医疗补助服务中心 (CMS) 于 2025 年 12 月 30 日宣布，“在联邦层面，医疗补助和儿童健康保险计划 (CHIP) 的支付与免疫质量指标的绩效无关”。
这项变更取消了与参加这些项目的儿童的疫苗接种率挂钩的联邦财政激励措施。
以前，包括儿童和青少年免疫接种状况在内的质量指标是强制性报告的一部分，会影响基于价值的支付和对医疗服务提供者的奖金。
2026 年儿童和成人核心集已删除四项关键免疫措施，现在报告为自愿性质。
美国卫生与公众服务部部长小罗伯特·F·肯尼迪将该政策描述为“保护医疗自由和知情同意”的举措，并强调医疗决策应优先考虑患者的福祉，而不是财务指标。
专家们对这一转变表示欢迎：
儿童健康保护组织首席执行官玛丽·霍兰德表示：“这种方向性的转变……有助于将疫苗重新归入其他所有医疗干预措施的范畴，这才是疫苗应有的位置。”
- James Lyons-Weiler 博士称其为“对儿童疫苗激励措施影响最大的联邦政策逆转”，也是“期待已久的重新平衡”的开始。
- 米歇尔·佩罗博士：指出将补偿与特定决定挂钩会削弱信任，而信任是儿科护理的基础。
从历史上看，此类激励措施（可以追溯到 20 世纪 90 年代末）一直受到批评，认为它们可能会影响临床判断，并给家庭带来压力。
CMS目前正在探索以知情同意、疫苗教育和尊重宗教豁免为重点的新措施。
各州仍可灵活维持自己的项目，但联邦政府的这一举措为优先考虑个性化护理和父母权利树立了先例。
这项改革代表着在恢复儿科医学领域的信任和伦理实践方面取得的重要进展。
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CMS Removes Federal Ties Between Physician Payments and Childhood Vaccination Rates in Medicaid and CHIP
In a major development for healthcare policy and medical ethics, the Centers for Medicare & Medicaid Services (CMS) announced on December 30, 2025, that it "does not tie payment to performance on immunization quality measures in Medicaid and CHIP at the federal level."
This change eliminates federal financial incentives linked to vaccination rates for children enrolled in these programs.
Previously, quality measures—including childhood and adolescent immunization status—were part of mandatory reporting that influenced value-based payments and bonuses for providers.
Four key immunization measures have been removed from the 2026 Child and Adult Core Sets, with reporting now voluntary.
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. described the policy as a step to "protect medical freedom and informed consent," emphasizing that medical decisions should prioritize patient well-being over financial metrics.
Experts have welcomed the shift:
- Mary Holland, CEO of Children’s Health Defense: “This directional change... helps to put vaccines back into the category of every other medical intervention, which is where they should be.”
- James Lyons-Weiler, Ph.D.: Called it “the most consequential federal policy reversal on pediatric vaccine incentives” and the start of a “long-overdue rebalancing.”
- Dr. Michelle Perro: Noted that tying compensation to specific decisions can erode trust, the foundation of pediatric care.
Historically, such incentives—dating back to the late 1990s—have been criticized for potentially influencing clinical judgment and contributing to pressure on families.
CMS is now exploring new measures focused on informed consent, vaccine education, and respect for religious exemptions.
States retain flexibility to maintain their own programs, but this federal action sets a precedent for prioritizing individualized care and parental rights.
This reform represents an important advancement in restoring trust and ethical practice in pediatric medicine.
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