Impact of vaccine financing on vaccinations delivered by health departmentclinics

Objectives. This study measured the number of childhood vaccinations delive red at health department clinics (HDCs) before and after changes in vaccine financing in 1994, and it assessed the impact of changes in financing on H DC operations. Methods. We measured the number of vaccination doses administered annually at all 57 HDCs in New York State between 1991 and 1996, before and after th e financing changes. Interviews of HDC personnel assessed the impact of fin ancing changes. A secondary study measured trends in Pennsylvania and Calif ornia, Results. HDC vaccinations for preschool children in New York State declined slightly prior to the financing changes (6%-8% between 1991 and 1993) but declined markedly thereafter (53%56% between 1993 and 1996). According to n early two thirds of New York State's HDCs, the primary cause for this decli ne was the vaccine-financing changes. HDC vaccinations for preschool childr en in Pennsylvania declined by 12% between 1991 and 1993 and by 56% between 1993 and 1997. HDC vaccinations for polio-containing vaccines in Californi a declined by 31% between 1993 and 1997. Conclusions. Substantially fewer vaccinations have been administered at HDC s since changes in vaccine financing, thereby keeping preschool children in their primary care medical homes.