title: Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing.
  
  
  METHODS
  A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States.
  
  
  METHODS
  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.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, PA 15261, USA. zimmer+@pitt.edu
authors.forename: R K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: A R
authors.initials: AR
authors.lastname: Medsger
authors.forename: E M
authors.initials: EM
authors.lastname: Ricci
authors.forename: M
authors.initials: M
authors.lastname: Raymund
authors.forename: T A
authors.initials: TA
authors.lastname: Mieczkowski
authors.forename: S
authors.initials: S
authors.lastname: Grufferman
mesh_terms: D002648:Child; D003153:Community Health Services; D005194:Family Practice / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007348:Insurance, Health; D016014:Linear Models; D008489:Medical Indigency; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data; D014612:Vaccines / Q000191:economics / Q000600:supply & distribution*
chemical_list: D014612:Vaccines