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September 24, 1997, Vol 278, No. 12 >
ARTICLE | September 24, 1997

Impact of Free Vaccine and Insurance Status on Physician Referral of Children to Public Vaccine Clinics FREE

Richard Kent Zimmerman, MD, MPH; Anne R. Medsger, RN, MSHyg; Edmund M. Ricci, PhD; Mahlon Raymund, PhD; Tammy A. Mieczkowski, MA; Seymour Grufferman, MD, DrPH
[+] Author Affiliations

Presented in part at Prevention 96, Dallas, Tex, March 24, 1996, and the 30th National Immunization Conference, Washington, DC, April 11, 1996.

Reprints: Richard Kent Zimmerman, MD, MPH, Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, M-200 Scaife Hall, Pittsburgh, PA 15261 (e-mail: zimmer+@pitt.edu).


JAMA. 1997;278(12):996-1000. doi:10.1001/jama.1997.03550120056033
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References

Context.  —Concerns about financial barriers to vaccination led to the development of the Vaccines for Children (VFC) program, which provides free vaccines to states for children who are uninsured, Medicaid eligible, or Native American or Native Alaskan.

Objective.  —To understand the effect of economic factors on physician likelihood of referring children to public vaccine clinics for immunizations and to evaluate the VFC program.

Design.  —A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing.

Setting and Participants.  —A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in officebased practices across the United States.

Main Outcome Measures.  —Likelihood of referral of a child to a health department for vaccination by child's insurance status and by the physician's receipt of free vaccines.

Results.  —Of the 1769 physicians with whom an interviewer spoke, 1236 participated. Most respondents (66%) were likely to refer an uninsured child to the health department for vaccination, whereas only 8% were likely to refer a child who had insurance that covers vaccination. The majority (58%) of physicians reported differential referral based on insurance status. Among physicians who received free vaccine supplies from the VFC program or elsewhere, 44% were likely to refer an uninsured child whereas 90% of those not receiving free vaccine were likely to refer the same child (P<.001). In regression analysis, the receipt of free vaccine supplies accounted for 24% of the variance in the likelihood to refer an uninsured child for vaccination.

Conclusions.  —Physicians receiving free vaccine supplies report being less likely to refer children to public clinics for vaccinations.

REFERENCES

1 +
Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives . Washington, DC: Public Health Service; 1991;.
2 +
Centers for Disease Control and Prevention.  Status report on the childhood immunization initiative: national, state, and urban area vaccination coverage levels among children aged 19 to 35 months—United States, 1996 . MMWR Morb Mortal Wkly Rep . 1997;;46:657-664.
3 +
National Vaccine Advisory Committee.  The measles epidemic: the problems, barriers, and recommendations . JAMA . 1991;;266:1547-1552.
4 +
Ruch-Ross HS, O'Connor KG.  Immunization referral practices of pediatricians in the United States . Pediatrics . 1994;;94:508-513.
5 +
Zimmerman RK, Schlesselman JJ, Baird AL, et al.  A national survey to understand why physicians limit childhood immunizations . Arch Pediatr Adolesc Med . 1997;;151:657-664.
6 +
Aday LA, ed. Designing and Conducting Health Surveys . San Francisco, Calif: Jossey-Bass Publishers Inc; 1989;.
7 +
Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons; 1977;.
8 +
SAS System for Windows [computer program]. Version 6.12. Cary, NC: SAS Institute Inc; 1996. 1 CD-ROM.
9 +
Schulte JM, Bown GR, Zetzman MR, et al.  Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988 . Pediatrics . 1991;;87:204-207.
10 +
Wright JA, Marcuse EK.  Immunization practices of Washington State pediatricians—1989 . AJDC . 1992;;146:1033-1036.
11 +
Bordley WC, Freed GL, Garrett JM, et al.  Factors responsible for immunizations referrals to health departments in North Carolina . Pediatrics . 1994;;94:376-380.
12 +
Zimmerman RK, Giebink GS, Street HB, et al.  The knowledge and attitudes of Minnesota primary care physicians about barriers to measles and pertussis immunization . J Am Board Fam Pract . 1995;; 8:270-277.
13 +
Zimmerman RK, Bradford BJ, Janosky JE, et al.  Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians . Am J Prev Med . 1997;;13:89-97.
14 +
Arnold PJ, Schlenker TL.  The impact of health care financing on childhood immunization practices . AJDC . 1992;;146:728-732.
15 +
Zimmerman RK, Janosky JE.  Immunization barriers in Minnesota private practices: the influence of economics and training on vaccine timing . Fam Pract Res J . 1993;;13:213-224.
16 +
Lurie N, Manning WG, Peterson C, et al.  Preventive care: do we practice what we preach? Am J Public Health . 1987;;77:801-804.
17 +
Murphy TV, Pastor P, Medley FB.  Factors associated with unnecessary immunization given to children . Pediatr Infect Dis J . 1997;;16:47-52.
18 +
Hamlin JS, Wood D, Pereyra M, et al.  Inappropriately timed immunizations: types, causes, and their relationship to record keeping . Am J Public Health . 1996;;86:1812-1814.
19 +
Murphy TV, Pastor P, Turner SB, et al.  Estimating immunization coverage from school-based childhood immunization records . Pediatr Infect Dis J . 1995;;15:561-567.
20 +
Holtmann AG.  The economics of US immunization policy . In: Pauly MV, Robinson CA, Sepe SJ, et al, eds. Supplying Vaccine: An Economic Analysis of Critical Issues . Amsterdam, the Netherlands: IOS Press; 1996;:153.
21 +
Fairbrother G, Friedman S, Hanson KL, et al. Impact of Vaccines for Children program (VFC) on inner-city neighborhood physicians. Arch Pediatr Adolesc Med. In press.
22 +
Taylor JA, Darden PM, Slora E, et al.  The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: a study from pediatric research in office settings . Pediatrics . 1997;;99:209-215.
23 +
Wood DL, Halfon N.  The impact of the Vaccine for Children program on child immunization delivery . Arch Pediatr Adolesc Med . 1996;;150:577-581.
24 +
US General Accounting Office. Vaccines for Children: Reexamination of Program Goals and Implementation Needed to Ensure Vaccination . Washington, DC: US General Accounting Office; 1995;.

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1 +
Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives . Washington, DC: Public Health Service; 1991;.
2 +
Centers for Disease Control and Prevention.  Status report on the childhood immunization initiative: national, state, and urban area vaccination coverage levels among children aged 19 to 35 months—United States, 1996 . MMWR Morb Mortal Wkly Rep . 1997;;46:657-664.
3 +
National Vaccine Advisory Committee.  The measles epidemic: the problems, barriers, and recommendations . JAMA . 1991;;266:1547-1552.
4 +
Ruch-Ross HS, O'Connor KG.  Immunization referral practices of pediatricians in the United States . Pediatrics . 1994;;94:508-513.
5 +
Zimmerman RK, Schlesselman JJ, Baird AL, et al.  A national survey to understand why physicians limit childhood immunizations . Arch Pediatr Adolesc Med . 1997;;151:657-664.
6 +
Aday LA, ed. Designing and Conducting Health Surveys . San Francisco, Calif: Jossey-Bass Publishers Inc; 1989;.
7 +
Cochran WG. Sampling Techniques . 3rd ed. New York, NY: John Wiley & Sons; 1977;.
8 +
SAS System for Windows [computer program]. Version 6.12. Cary, NC: SAS Institute Inc; 1996. 1 CD-ROM.
9 +
Schulte JM, Bown GR, Zetzman MR, et al.  Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988 . Pediatrics . 1991;;87:204-207.
10 +
Wright JA, Marcuse EK.  Immunization practices of Washington State pediatricians—1989 . AJDC . 1992;;146:1033-1036.
11 +
Bordley WC, Freed GL, Garrett JM, et al.  Factors responsible for immunizations referrals to health departments in North Carolina . Pediatrics . 1994;;94:376-380.
12 +
Zimmerman RK, Giebink GS, Street HB, et al.  The knowledge and attitudes of Minnesota primary care physicians about barriers to measles and pertussis immunization . J Am Board Fam Pract . 1995;; 8:270-277.
13 +
Zimmerman RK, Bradford BJ, Janosky JE, et al.  Barriers to measles and pertussis immunization: the knowledge and attitudes of Pennsylvania primary care physicians . Am J Prev Med . 1997;;13:89-97.
14 +
Arnold PJ, Schlenker TL.  The impact of health care financing on childhood immunization practices . AJDC . 1992;;146:728-732.
15 +
Zimmerman RK, Janosky JE.  Immunization barriers in Minnesota private practices: the influence of economics and training on vaccine timing . Fam Pract Res J . 1993;;13:213-224.
16 +
Lurie N, Manning WG, Peterson C, et al.  Preventive care: do we practice what we preach? Am J Public Health . 1987;;77:801-804.
17 +
Murphy TV, Pastor P, Medley FB.  Factors associated with unnecessary immunization given to children . Pediatr Infect Dis J . 1997;;16:47-52.
18 +
Hamlin JS, Wood D, Pereyra M, et al.  Inappropriately timed immunizations: types, causes, and their relationship to record keeping . Am J Public Health . 1996;;86:1812-1814.
19 +
Murphy TV, Pastor P, Turner SB, et al.  Estimating immunization coverage from school-based childhood immunization records . Pediatr Infect Dis J . 1995;;15:561-567.
20 +
Holtmann AG.  The economics of US immunization policy . In: Pauly MV, Robinson CA, Sepe SJ, et al, eds. Supplying Vaccine: An Economic Analysis of Critical Issues . Amsterdam, the Netherlands: IOS Press; 1996;:153.
21 +
Fairbrother G, Friedman S, Hanson KL, et al. Impact of Vaccines for Children program (VFC) on inner-city neighborhood physicians. Arch Pediatr Adolesc Med. In press.
22 +
Taylor JA, Darden PM, Slora E, et al.  The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: a study from pediatric research in office settings . Pediatrics . 1997;;99:209-215.
23 +
Wood DL, Halfon N.  The impact of the Vaccine for Children program on child immunization delivery . Arch Pediatr Adolesc Med . 1996;;150:577-581.
24 +
US General Accounting Office. Vaccines for Children: Reexamination of Program Goals and Implementation Needed to Ensure Vaccination . Washington, DC: US General Accounting Office; 1995;.

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