This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

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

JAMA. 1997;278(12):996-1000.

Abstract
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.

Author Affiliations
From the Department of Family Medicine and Clinical Epidemiology, School of Medicine (Drs Zimmerman, Raymund, and Grufferman and Ms Mieczkowski), and the Department of Health Services Administration, Graduate School of Public Health (Drs Zimmerman and Ricci and Ms Medsger), University of Pittsburgh, Pittsburgh, Pa.

Footnotes
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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program
Smith et al.
Pediatrics 2005;116:130-139.
ABSTRACT | FULL TEXT  

Physician Reimbursement Levels and Adherence to American Academy of Pediatrics Well-Visit and Immunization Recommendations
McInerny et al.
Pediatrics 2005;115:833-838.
ABSTRACT | FULL TEXT  

The Fragility of the U.S. Vaccine Supply
Sloan et al.
NEJM 2004;351:2443-2447.
FULL TEXT  

The Cost of Giving Childhood Vaccinations: Differences Among Provider Types
Glazner et al.
Pediatrics 2004;113:1582-1587.
ABSTRACT | FULL TEXT  

Physician Attitudes and Beliefs Associated with Patient Pneumococcal Polysaccharide Vaccination Status
Santibanez et al.
Ann Fam Med 2004;2:41-48.
ABSTRACT | FULL TEXT  

Standards for Child and Adolescent Immunization Practices
National Vaccine Advisory Committee
Pediatrics 2003;112:958-963.
FULL TEXT  

Child and Adolescent Immunizations: New Recommendations, New Standards, New Opportunities
Kohrt
Pediatrics 2003;112:978-981.
FULL TEXT  

Maternal Characteristics Associated With Vaccination of Young Children
Luman et al.
Pediatrics 2003;111:1215-1218.
ABSTRACT | FULL TEXT  

Vaccination Coverage and Physician Distribution in the United States, 1997
LeBaron et al.
Pediatrics 2001;107:31e-31.
ABSTRACT | FULL TEXT  

The Impact of Record Scattering on the Measurement of Immunization Coverage
Stokley et al.
Pediatrics 2001;107:91-96.
ABSTRACT | FULL TEXT  

Vaccines for Children Program, United States, 1997
Santoli et al.
Pediatrics 1999;104:15e-15.
ABSTRACT | FULL TEXT  

Strategies to Sustain Success in Childhood Immunizations
The National Vaccine Advisory Committee
JAMA 1999;282:363-370.
ABSTRACT | FULL TEXT  

Assessing Quality of Care via HEDIS 3.0: Is There a Better Way?
Mainous III and Talbert
Arch Fam Med 1998;7:410-413.
ABSTRACT | FULL TEXT  

A Population-based Study of Access to Immunization Among Urban Virginia Children Served By Public, Private, and Military Health Care Systems
Morrow et al.
Pediatrics 1998;101 :e5-e5.
ABSTRACT | FULL TEXT  

IMPACT OF INSURANCE AND FREE VACCINES ON CHILDHOOD IMMUNIZATIONS
JWatch General 1997;1997:5-5.
FULL TEXT