Open Access Open Badges Research article

Impact of vaccine economic programs on physician referral of children to public vaccine clinics: a pre-post comparison

Richard K Zimmerman12*, Melissa Tabbarah1, Janine E Janosky1, Barbara Bardenheier3, Judith A Troy1, Ilene K Jewell2 and Barbara P Yawn4

  • * Corresponding author: Richard K Zimmerman

  • † Equal contributors

Author Affiliations

1 Department of Family Medicine and Clinical Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

2 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

3 Health Services Research and Evaluation Branch, Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA, USA

4 Olmsted Medical Group, Department of Research, Rochester, MN, USA

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BMC Public Health 2006, 6:7  doi:10.1186/1471-2458-6-7

Published: 12 January 2006



The Vaccines for Children (VFC) Program is a major vaccine entitlement program with limited long-term evaluation. The objectives of this study are to evaluate the effect of VFC on physician reported referral of children to public health clinics and on doses administered in the public sector.


Minnesota and Pennsylvania primary care physicians (n = 164), completed surveys before (e.g., 1993) and after (2003) VFC, rating their likelihood on a scale of 0 (very unlikely) to 10 (very likely) of referring a child to the health department for immunization.


The percentage of respondents likely to refer was 60% for an uninsured child, 14% for a child with Medicaid, and 3% for a child with insurance that pays for immunization. Half (55%) of the physicians who did not participate in VFC were likely to refer a Medicaid-insured child, as compared with 6% of those who participated (P < 0.001). Physician likelihood to refer an uninsured child for vaccination, measured on a scale of 0 to 10 where 10 is very likely, decreased by a mean difference of 1.9 (P < 0.001) from pre- to post-VFC. The likelihood to refer a Medicaid-insured child decreased by a mean of 1.2 (P = 0.001).


Reported out-referral to public clinics decreased over time. In light of increasing immunizations rates, this suggests that more vaccines were being administered in private provider offices.