Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics

JAMA. 1997 Sep 24;278(12):996-1000.


Context: Concerns about financial barriers to vaccination led to the development of the Vaccines for Children (VFC) program, which provides free vaccines to states for children who are uninsured, Medicaid eligible, or Native American or Native Alaskan.

Objective: To understand the effect of economic factors on physician likelihood of referring children to public vaccine clinics for immunizations and to evaluate the VFC program.

Design: A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing.

Setting and participants: A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States.

Main outcome measures: Likelihood of referral of a child to a health department for vaccination by child's insurance status and by the physician's receipt of free vaccines.

Results: Of the 1769 physicians with whom an interviewer spoke, 1236 participated. Most respondents (66%) were likely to refer an uninsured child to the health department for vaccination, whereas only 8% were likely to refer a child who had insurance that covers vaccination. The majority (58%) of physicians reported differential referral based on insurance status. Among physicians who received free vaccine supplies from the VFC program or elsewhere, 44% were likely to refer an uninsured child whereas 90% of those not receiving free vaccine were likely to refer the same child (P<.001). In regression analysis, the receipt of free vaccine supplies accounted for 24% of the variance in the likelihood to refer an uninsured child for vaccination.

Conclusions: Physicians receiving free vaccine supplies report being less likely to refer children to public clinics for vaccinations.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child
  • Community Health Services
  • Family Practice / economics
  • Humans
  • Immunization Programs / statistics & numerical data*
  • Insurance, Health
  • Linear Models
  • Medical Indigency*
  • Multivariate Analysis
  • Practice Patterns, Physicians' / economics*
  • Referral and Consultation / economics
  • Referral and Consultation / statistics & numerical data
  • Regression Analysis
  • United States
  • Vaccination / economics*
  • Vaccination / statistics & numerical data
  • Vaccines / economics
  • Vaccines / supply & distribution*


  • Vaccines