Impact of a new universal purchase vaccine program in North Carolina
G. L. Freed, S. J. Clark, D. E. Pathman, T. R. Konrad, A. K. Biddle and R. M. Schectman
Division of Community Pediatrics, University of North Carolina at Chapel Hill, USA. freed@mail.schsr.unc.edu
OBJECTIVE: To explore the effects of state universal purchase (UP) of
vaccines for all children, regardless of income or insurance status, on
North Carolina physicians and families. DESIGN: Cross-sectional survey.
PARTICIPANTS: Pediatricians and family physicians (N = 2163) were surveyed
in 1995 to compare immunization charges in North Carolina (new UP) with
those of Massachusetts (UP) and Texas (free market). MAIN OUTCOME MEASURES:
Patient charges for immunizations and well-child visits and physician
perceptions of the effects of state immunization programs. Models were
devised to simulate the net effect of the North Carolina UP program on
immunization revenue for physicians and on families' out-of-pocket costs
for well-child care. RESULTS: Physician participation rates in the 2 UP
programs were very high. North Carolina physicians reported substantial
decreases in immunization charges and reduced referrals to public clinics,
but thought that UP increased their administrative burden. Sixty percent of
North Carolina physicians increased charges for well-child visits, nearly
twice that in the 2 control states. Families who previously had received
immunizations from public clinics but chose to remain in the private-sector
"medical home" for immunizations after implementation of UP had increased
out-of-pocket expenses that varied by their insurance status. CONCLUSIONS:
The North Carolina UP program is effective in decreasing patient
immunization charges and reducing referrals to public clinics. However, UP
does not eliminate cost as a barrier to immunization, nor does it enable
all children to remain in their medical homes. Underinsured children still
may face considerable financial barriers to immunization in a UP system.
