IMPACT OF FREE VACCINE AND INSURANCE STATUS ON PHYSICIAN REFERRAL OF CHILDREN TO PUBLIC VACCINE CLINICS

Context.-Concerns about financial barriers to vaccination led to the d evelopment of the Vaccines for Children (VFC) program, which provides free vaccines to states for children who are uninsured, Medicaid eligi ble, or Native American or Native Alaskan. Objective.-To understand th e effect of economic factors on physician likelihood of referring chil dren to public vaccine clinics for immunizations and to evaluate the V FC program. Design.-A standardized survey was conducted in 1995 by tra ined personnel using computer-assisted telephone interviewing. Setting and Participants.-A stratified random sample of family physicians, pe diatricians, and general practitioners younger than 65 years who were in office-based practices across the United States. Main Outcome Measu res.-Likelihood of referral of a child to a health department for vacc ination by child's insurance status and by the physician's receipt of free vaccines. Results.-Of the 1769 physicians with whom an interviewe r spoke, 1236 participated, Most respondents (66%) were likely to refe r an uninsured child to the health department for vaccination, whereas only 8% were likely to refer a child who had insurance that covers va ccination, The majority (58%) of physicians reported differential refe rral based on insurance status. Among physicians who received free vac cine supplies from the VFC program or elsewhere, 44% were likely to re fer an uninsured child whereas 90% of those not receiving free vaccine were likely to refer the same child (P<.001). In regression analysis, the receipt of free vaccine supplies accounted for 24% of the varianc e in the likelihood to refer an uninsured child for vaccination. Concl usions.-Physicians receiving free vaccine supplies report being less l ikely to refer children to public clinics for vaccinations.