title: Underinsurance and pediatric immunization delivery in the United States.
abstract: BACKGROUND
  Underinsured children are covered by private health insurance that does not cover the cost of vaccines, are not entitled to receive publicly purchased vaccines at no cost through the Vaccines for Children (VFC) Program unless they receive doses at a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), may be referred by their primary care providers to health department clinics (HDCs) for vaccinations, and may have lower vaccination coverage for new and more expensive vaccines.
  
  
  OBJECTIVE
  To describe the estimated percentage of children in the U.S. who are underinsured, receive vaccine doses at HDCs, and are not VFC-entitled; and to evaluate the association between being underinsured, receiving vaccine doses at an HDC, and timely vaccination coverage.
  
  
  METHODS
  Subjects were 16,621 19-35 month-old children sampled by the National Immunization Survey in 2007.
  
  
  RESULTS
  Of all 19-35 month-old children, an estimated 10.5% were underinsured; and an estimated 1.4% were underinsured, received doses at an HDC, and were not VFC-entitled. Compared to fully insured children, children who were underinsured and received doses at an HDC had significantly lower vaccination coverage for the varicella (81.5% vs. 87.7%, p < 0.05) and PCV7 (55.1% vs. 75.9%, p < 0.05) vaccines.
  
  
  CONCLUSIONS
  Children who were underinsured and received doses at HDCs were found to have lower estimated timely vaccination coverage for recently recommended vaccines and more expensive varicella and PCV7 vaccines. To adequately vaccinate these children at HDCs, states require stable funding to pay for vaccines as the number of new and more expensive vaccines grows.
authors: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA 30333, USA. pzs6@cdc.gov
authors: Philip J
authors: PJ
authors: Smith
authors: Noelle-Angelique
authors: NA
authors: Molinari
authors: Lance E
authors: LE
authors: Rodewald
mesh_terms: D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D005380:Financing, Government / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007115:Immunization Schedule; D007223:Infant; D019458:Insurance Coverage / Q000191:economics; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics*; D014481:United States; D014611:Vaccination / Q000191:economics*