Arnold P J, Schlenker T L
School of Business Administration, University of Wisconsin, Milwaukee.
Am J Dis Child. 1992 Jun;146(6):728-32. doi: 10.1001/archpedi.1992.02160180088023.
To examine the impact of patient insurance status and third-party payment methods on physician immunization practices.
Family practice physicians and pediatricians were surveyed to determine whether differences existed in office immunization practices for five childhood vaccines across insurance and payment classes.
Milwaukee, Wis.
Of 202 Milwaukee area physicians who administer immunizations routinely, 161 (79.7%) returned the questionnaire.
Physicians reported immunizing uninsured patients in their offices less often than patients with insurance. When insurance does not pay for immunizations, most physicians (81.6%) said that they left the decision of whether to pay for private immunizations or seek free immunizations from the city health department to the family. Physicians estimated that approximately half of their uninsured patients decline private immunizations. Some physicians (20%) who treat patients receiving Medicaid reported that they immunize patients with Title 19 coverage less often than patients with other types of insurance. No significant differences in frequency of immunization were reported for patients insured by capitated-payment health maintenance organizations, fee-for-service health maintenance organizations, or traditional insurance covering immunizations.
Physicians reported that they do not immunize uninsured and underinsured children as frequently as insured children. Further research is recommended to evaluate the impact of Medicaid enrollment on access to immunization and to develop innovative financing arrangements to ensure that no children leave their physicians' offices without being immunized.
探讨患者保险状况和第三方支付方式对医生免疫接种行为的影响。
对家庭医生和儿科医生进行调查,以确定在不同保险和支付类别下,五种儿童疫苗的门诊免疫接种行为是否存在差异。
威斯康星州密尔沃基市
在202名常规进行免疫接种的密尔沃基地区医生中,161名(79.7%)回复了问卷。
医生报告称,在其诊所为未参保患者进行免疫接种的频率低于参保患者。当保险不支付免疫接种费用时,大多数医生(81.6%)表示,他们将是否支付自费免疫接种费用或从城市卫生部门寻求免费免疫接种的决定权交给了家庭。医生估计,他们约一半的未参保患者拒绝自费免疫接种。一些治疗接受医疗补助患者的医生(20%)报告称,他们为有第19类保险覆盖的患者进行免疫接种的频率低于其他类型保险的患者。对于由按人头付费的健康维护组织、按服务收费的健康维护组织或涵盖免疫接种的传统保险承保的患者,免疫接种频率未报告有显著差异。
医生报告称,他们为未参保和保险不足儿童进行免疫接种的频率不如参保儿童高。建议进一步开展研究,以评估医疗补助登记对免疫接种可及性的影响,并制定创新的融资安排,以确保没有儿童在未接种疫苗的情况下离开医生诊所。