title: Relationship between primary payer and use of proactive immunization practices: a national survey.
abstract: OBJECTIVE
  To quantify the national use and determinants of proactive immunization practices by examining the relationship to the primary practice payer.
  
  
  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 across the United States was selected from the American Medical Association master file of physicians list, which included nonmembers. The main outcome measures were use of reminder systems and assessment of immunization rates.
  
  
  RESULTS
  Of the 1769 physicians who were contacted, 1236 participated. Use of reminder systems varied by the practice's primary payer: 31% of health maintenance organization (HMO), 41% of Medicaid, 27% of fee-for-service (FFS), and 28% of no predominant payment source physicians reported using a reminder system (P < 0.01). Use of computerized reminders also varied according to practice primary payer (HMO, 68%; Medicaid, 34%; FFS, 51%; and no predominant payment source, 42%; P < 0.01) as did assessment of immunization rates in the practice (HMO, 57%; Medicaid, 40%; FFS, 28%; and no predominant payment source, 30%; P < 0.01). A majority of Medicaid physicians (84%) required a physical examination before immunization, compared to 49% of HMO, 56% of FFS, and 63% of no predominant source physicians (P < 0.01).
  
  
  CONCLUSIONS
  The primary payment source of a practice appears to influence use of proactive immunization practices.
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: T A
authors.initials: TA
authors.lastname: Mieczkowski
authors.forename: M
authors.initials: M
authors.lastname: Raymund
mesh_terms: D002648:Child; D002675:Child, Preschool; D018588:Fee-for-Service Plans / Q000191:economics; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D007357:Insurance, Physician Services / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics*; D014481:United States