Effect of the vaccines for children program on physician referral of children to public vaccine clinics: A pre-post comparison

Objective. Started in late 1994, the Vaccines for Children (VFC) program is a major entitlement program that provides states with free vaccines for di sadvantaged children. Some evaluation studies have been conducted, but they do not include individually matched pre-post comparisons of physician resp onses. This project studied the effect of the VFC on the physician likeliho od of referring children to public vaccine clinics for immunizations. Design. In 1999, trained personnel conducted a survey of a cohort of physic ians who previously participated in surveys on barriers to childhood vaccin ation conducted before VFC implementation. Responses were matched, and pre- versus post-VFC comparisons were made. Setting and Participants. Minnesota and Pennsylvania primary care physician s selected by stratified random sampling and initially studied in 1990 to 1 991 and 1993, respectively. Main Outcome Measures. Likelihood of referral of a child to a public vaccin e clinic. Results. On a scale of 0 to 10, physician likelihood of referring an uninsu red child decreased by a mean of 1.9 (95% confidence interval: 1.2-2.5) fro m pre- to post-VFC. Two fifths (45%) of physicians reported that the VFC de creased the number of referrals from their practice to public vaccine clini cs and 50% gave intermediate responses. Among physicians who participate in VFC, only 9% were likely to refer a Medicaid-insured child in contrast to 44% of those not participating. Conclusions. Physicians' reported referral and likelihood of referring Medi caid-insured and uninsured children has decreased because of VFC in Minneso ta and Pennsylvania.