THE IMPACT OF HEALTH-CARE FINANCING ON CHILDHOOD IMMUNIZATION PRACTICES

Objective. - To examine the impact of patient insurance status and third-party payment methods on physician immunization practices. Design. - Family practice physicians and pediatricians were surveyed to determine whether differences existed in office immunization practices for five childhood vaccines across insurance and payment classes. Setting. - Milwaukee, Wis. Participants. - Of 202 Milwaukee area physicians who administer immunizations routinely, 161 (79.7%) returned the questionnaire. Results. - Physicians reported immunizing uninsured patients in their offices less often than patients with insurance. When insurance does not pay for immunizations, most physicians (81.6%) said that they left the decision of whether to pay for private immunizations or seek free immunizations from the city health department to the family. Physicians estimated that approximately half of their uninsured patients decline private immunizations. Some physicians (20%) who treat patients receiving Medicaid reported that they immunize patients with Title 19 coverage less often than patients with other types of insurance. No significant differences in frequency of immunization were reported for patients insured by capitated-payment health maintenance organizations, fee-for-service health maintenance organizations, or traditional insurance covering immunizations. Conclusions. - Physicians reported that they do not immunize uninsured and underinsured children as frequently as insured children. Further research is recommended to evaluate the impact of Medicaid enrollment on access to immunization and to develop innovative financing arrangements to ensure that no children leave their physicians' offices without being immunized.