Use of public immunization services after initiation of a universal vaccine purchase program.
OBJECTIVE
To explore the reasons why North Carolina families continue to use public immunization services 2 years after implementation of a universal vaccine purchase program, a state program intended to eliminate financial barriers to immunization in private physicians' offices.


METHODS
In-person interviews were conducted in 11 local public health departments in North Carolina.


METHODS
Consecutive sample of 64 adults accompanying children aged 2 years or younger presenting for immunization services.


METHODS
(1) Reasons for seeking immunization at the health department and (2) history of immunization from private physicians.


RESULTS
Two thirds of children obtained immunizations at the health department because of cost, including two thirds of children enrolled in Medicaid. Only 33% of children received well-child care from a private physician; for more than half of this group, the parents cited cost as the reason for using the health department, even though their physician was participating in the state universal purchase program. Of the 8 parents who told their child's private physician that they could not afford immunizations, none was told that the vaccine administration fee would be waived.


CONCLUSIONS
Even though North Carolina's universal vaccine purchase program had been in effect for more than 2 years, a substantial number of children still received care from a private physician but used the health department for immunizations because of cost. These results indicate a need to explore additional strategies to preserve children's "medical homes."
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA.
S J
SJ
Clark
G L
GL
Freed
D000328:Adult; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D007407:Interviews as Topic; D008484:Medicaid; D009657:North Carolina; D011634:Public Health; D014481:United States; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data