The impact of health care financing on childhood immunization practices
P. J. Arnold and T. L. Schlenker
School of Business Administration, University of Wisconsin, Milwaukee.
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.
