title: Effect of the Vaccines for Children program on physician referral of children to public vaccine clinics: a pre-post comparison.
abstract: OBJECTIVE
  Started in late 1994, the Vaccines for Children (VFC) program is a major entitlement program that provides states with free vaccines for disadvantaged children. Some evaluation studies have been conducted, but they do not include individually matched pre-post comparisons of physician responses. This project studied the effect of the VFC on the physician likelihood of referring children to public vaccine clinics for immunizations.
  
  
  METHODS
  In 1999, trained personnel conducted a survey of a cohort of physicians who previously participated in surveys on barriers to childhood vaccination conducted before VFC implementation. Responses were matched, and pre- versus post-VFC comparisons were made.
  
  
  METHODS
  Minnesota and Pennsylvania primary care physicians selected by stratified random sampling and initially studied in 1990 to 1991 and 1993, respectively.
  
  
  METHODS
  Likelihood of referral of a child to a public vaccine clinic.
  
  
  RESULTS
  On a scale of 0 to 10, physician likelihood of referring an uninsured child decreased by a mean of 1.9 (95% confidence interval: 1.2-2.5) from pre- to post-VFC. Two fifths (45%) of physicians reported that the VFC decreased the number of referrals from their practice to public vaccine clinics and 50% gave intermediate responses. Among physicians who participate in VFC, only 9% were likely to refer a Medicaid-insured child in contrast to 44% of those not participating.
  
  
  CONCLUSIONS
  Physicians' reported referral and likelihood of referring Medicaid-insured and uninsured children has decreased because of VFC in Minnesota and Pennsylvania.vaccination/economics, vaccination/legislation and jurisprudence, immunization programs/economics, immunization programs/utilization, vaccines/economics, Medicaid/economics, national health programs United States, child health services.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 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: H M
authors.initials: HM
authors.lastname: Mainzer
authors.forename: A R
authors.initials: AR
authors.lastname: Medsger
authors.forename: M
authors.initials: M
authors.lastname: Raymund
authors.forename: J A
authors.initials: JA
authors.lastname: Ball
authors.forename: I K
authors.initials: IK
authors.lastname: Jewell
mesh_terms: D002204:Capitation Fee / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002669:Child Welfare; D005249:Fees and Charges / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D008489:Medical Indigency / Q000191:economics / Q000706:statistics & numerical data; D008910:Minnesota; D015999:Multivariate Analysis; D010414:Pennsylvania; D010821:Physicians, Family / Q000706:statistics & numerical data* / Q000639:trends; D015980:Public Health Practice; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*