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Sarah J. Clark, MPH; Gary L. Freed, MD, MPH

Arch Pediatr Adolesc Med. 1998;152:642-645.

Objective  To explore the reasons why North Carolina families continue to use public immunization services 2 years after implementation of a universal vaccine purchase program, a state program intended to eliminate financial barriers to immunization in private physicians' offices.

Methods  In-person interviews were conducted in 11 local public health departments in North Carolina.

Participants  Consecutive sample of 64 adults accompanying children aged 2 years or younger presenting for immunization services.

Main Outcome Measures  (1) Reasons for seeking immunization at the health department and (2) history of immunization from private physicians.

Results  Two thirds of children obtained immunizations at the health department because of cost, including two thirds of children enrolled in Medicaid. Only 33% of children received well-child care from a private physician; for more than half of this group, the parents cited cost as the reason for using the health department, even though their physician was participating in the state universal purchase program. Of the 8 parents who told their child's private physician that they could not afford immunizations, none was told that the vaccine administration fee would be waived.

Conclusions  Even though North Carolina's universal vaccine purchase program had been in effect for more than 2 years, a substantial number of children still received care from a private physician but used the health department for immunizations because of cost. These results indicate a need to explore additional strategies to preserve children's "medical homes."

From the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Ms Clark is now with the Division of General Pediatrics, University of Michigan Medical Center, Ann Arbor.

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