title: Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?
abstract: BACKGROUND
  Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates.
  
  
  METHODS
  The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1-Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.
  
  
  RESULTS
  The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021).
  
  
  CONCLUSIONS
  The P4P program had a limited impact on vaccination rates and did not address health inequity.
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. alan_katz@cpe.umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. alan_katz@cpe.umanitoba.ca.
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. jennifer_enns@cpe.umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. jennifer_enns@cpe.umanitoba.ca.
authors.forename: Jennifer Emily
authors.initials: JE
authors.lastname: Enns
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. dan_chateau@cpe.umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. dan_chateau@cpe.umanitoba.ca.
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. lisa.lix@umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. lisa.lix@umanitoba.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lix
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. dpjutte@berkeley.edu.|School of Public Health, University of California, 50 University Hall, #7360, Berkeley, CA, 94720-7360, USA. dpjutte@berkeley.edu.
authors.forename: Doug
authors.initials: D
authors.lastname: Jutte
authors.affiliation: Winnipeg Regional Health Authority, Primary Health Care and Chronic Disease, 496 Hargrave St, Winnipeg, MB, R3A 0X7, Canada. jedwards@wrha.mb.ca.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Edwards
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. marni_brownell@cpe.umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. marni_brownell@cpe.umanitoba.ca.
authors.forename: Marni
authors.initials: M
authors.lastname: Brownell
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. cmetge@wrha.mb.ca.|Winnipeg Regional Health Authority, 200-1155 Concordia Ave, Winnipeg, MB, R2K 2M9, Canada. cmetge@wrha.mb.ca.
authors.forename: Colleen
authors.initials: C
authors.lastname: Metge
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. nathan_nickel@cpe.umanitoba.ca.|Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada. nathan_nickel@cpe.umanitoba.ca.
authors.forename: Nathan
authors.initials: N
authors.lastname: Nickel
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. carole_taylor@cpe.umanitoba.ca.
authors.forename: Carole
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. elaine_burland@cpe.umanitoba.ca.
authors.forename: Elaine
authors.initials: E
authors.lastname: Burland
mesh_terms: D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D058007:Physicians, Primary Care; D012052:Reimbursement, Incentive / Q000191:economics* / Q000592:standards; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*