Decline in physician referrals to health department clinics for immunizations - The role of vaccine financing

Background: Physicians frequently refer children to health department clini cs (HDCs) for immunizations because of high out-of-pocket costs to parents and Door reimbursement for providers. Referrals for immunizations can lead to scattered care. In 1994, two vaccine financing reforms began in New York State that reduced patient costs and improved provider reimbursement: the Vaccines for Children Program (VFC, mostly for those on Medicaid and uninsu red) and a law requiring indemnity insurers to cover childhood immunization s and preventive services. Objective: To measure reported changes in physician referrals to HDCs for i mmunizations before and after the vaccine financing reforms. Design: In 1993, a self-administered sun ey measured immunization referral practices of primary care physicians. In 1997, we resurveyed respondents: o f the 1993 survey to evaluate changes in referrals. Setting/Participants: Three hundred twenty-eight eligible New York State pr imary care physicians (65% pediatricians and 35% family physicians) who res ponded to the 1997 follow-up, immunization survey (response rate of 82%). Results: The proportion of physicians reporting that they referred some or all children out for immunizations decreased from 51% in 1993 to 18% in 199 7 (p<0.001). In 1997, physicians were more likely to refer if they were fam ily physicians (28% vs, 13%, P<0.01), or did not obtain VFC vaccines (29% v s. 13%, P<0.001). According to physicians who referred in 1993, decreased r eferrals in 1997 were due to the new insurance laws (noted by 61%), VFC (60 %), Child Health Plus (a statewide insurance program for Door children, 28% ), growth in commercial managed care (23%), Medicaid managed care (19%), an d higher Medicaid reimbursement for immunizations that is due to VFC (18%). For physicians noting a decline in referrals, the magnitude of the decline was substantial-60% fewer referrals for VFC-eligible patients and 50% fewe r for patients eligible under the new insurance law. Conclusions: Vaccine financing reforms decreased the proportion of physicia ns who referred children to HDCs for immunizations, and may have reduced sc attering of pediatric care.