THE IMPACT OF THE MEDICARE INFLUENZA DEMONSTRATION PROJECT ON INFLUENZA VACCINATION IN A COUNTY IN MASSACHUSETTS, 1988-1992

Influenza and related pneumonia continue to cause significant amounts of morbidity and mortality despite the availability of effective vacci nes. Two comparable counties in Massachusetts served as project areas of a national trial to see if reimbursement for immunizing Medicare-B eligible recipients against influenza would increase the use of the va ccine and reduce the costs attributed to related morbidity. Providers of health and social services to elders were recruited to participate in one county. A variety of professional and public education campaign s and media were used to promote influenza immunizations. Laboratory-b ased surveillance was instituted in both counties to assess the extent of circulating virus in each. Vaccine was made available to medical p roviders in both counties. While the amount of vaccine used in the com parison county increased by 6% from pre-project time (16,000 to 17,000 doses administered), vaccine use increased 219% in the intervention c ounty (21,250 to 46,494 doses administered). In a post-project survey of participating physicians, 88% of 238 respondents reported administe ring less than 100 doses of influenza vaccine per year prior to the pr oject. By the end of the project, only 32% administered less than 100 in the previous year. This project demonstrated the need for educating both the provider and the public in order to successfully promote imm unizations. It was not clear, however, if reimbursement was a more imp ortant factor for promoting influenza immunizations than was universal distribution of free vaccine.