title: The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study.
abstract: BACKGROUND
  Flu vaccination is recommended annually for high risk groups. However, in Ireland, free access to vaccination is not universal for those in high risk groups; the vaccine and consultation are only free for those with a medical card, a means tested scheme. Few private health insurance policies cover the cost of attendance for vaccination in general practice. The aim was to examine the influence of this reimbursement policy on vaccination coverage among older adults.
  
  
  METHODS
  Cross-sectional wave 1 data from The Irish Longitudinal Study on Ageing (TILDA) were analysed (2009-2011). TILDA is a nationally representative prospective cohort study of adults aged ≥50, sampled using multistage stratified clustered sampling. Self-reported entitlement to healthcare was categorised as 1) medical card only 2) private health insurance only, 3) both and 4) neither. The outcome was responses to 'have you ever had a flu shot'. Multivariate logistic regression was used, adjusting for age and need.
  
  
  RESULTS
  68.6% of those defined as clinically high-risk received the flu vaccination in the past (95% CI = 67-71%). Those with a medical card were almost twice as likely to have been vaccinated, controlling for age and chronic illness (OR = 1.9, 95% CI = 1.5-2.5, p = <0.001).
  
  
  CONCLUSIONS
  Having a medical card increased the likelihood of being vaccinated, independent of age and need. The mismatch between vaccination guidelines and reimbursement policy is creating unequal access to recommended services among high risk groups.
authors: Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland. s.mchugh@ucc.ie.
authors: Sheena M
authors: SM
authors: Mc Hugh
authors: Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland. j.browne@ucc.ie.
authors: John
authors: J
authors: Browne
authors: School of Business and Economics, National University of Ireland, Galway, Ireland. ciaran.oneill@nuigalway.ie.
authors: Ciaran
authors: C
authors: O'Neill
authors: Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland. patricia.kearney@ucc.ie.
authors: Patricia M
authors: PM
authors: Kearney
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000191:economics*; D007494:Ireland; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors
chemical_list: D007252:Influenza Vaccines
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