Public Release: 

Vaccination reform may improve consistency of care for children

Center for Advancing Health

The reform of vaccination financing may help prevent the scattering of pediatric care, as well as underimmunization of children, suggest the results of a New York State-based study.

Researchers from the University of Rochester School of Medicine and Dentistry and the Centers for Disease Control and Prevention in Atlanta, Ga., compared the immunization policies of New York physicians before and after the state enacted two vaccine-financing reforms in 1994.

One reform, called "Vaccines for Children," was geared mainly toward families on Medicaid and the uninsured; the other, called the "First Dollar Law," was designed to aid underinsured children.

As the cost of a full series of vaccines increased in the U.S. during the 1980s and early 1990s, more physicians began referring children to health department clinics for immunizations. In 1992 nearly half of U.S. pediatricians referred at least some of their patients for immunizations, according to the study.

"Problems that occur when patients are referred rather than kept under one primary care roof include scattered care, scattered vaccination records, and underimmunization, which can add an increased burden to patients already disadvantaged because of poverty," said lead author Peter G. Szilagyi, MD, of the University of Rochester School of Medicine and Dentistry in Rochester, NY.

The researchers found that physicians were far less likely to refer children out for immunizations after the reforms were passed--the percentage of referrals decreased from 51 percent in 1993 to 18 percent in 1997. The researchers report their results in the May 2000 issue of the American Journal of Preventive Medicine.

Also, physicians attributed their decreased referrals primarily to the two reforms--61 percent stated that Vaccines for Children had decreased referrals, and 57 percent reported that the First Dollar Law had decreased referrals.

"Our findings suggests that removing financial barriers for both patients and physicians dramatically reduces referrals for immunizations," said Szilagyi.

"Based on the decline in physician-reported referrals to health department clinics for childhood immunizations, vaccine financing reforms appear to be effective in keeping children in their primary care medical homes," concluded Szilagyi.

This study was supported in part by the Centers for Disease Control and Prevention.


The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the journal, contact the editorial office at 619-594-7344.

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