Zimmerman R K, Medsger A R, Ricci E M, Raymund M, Mieczkowski T A, Grufferman S
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, PA 15261, USA. zimmer+@pitt.edu
JAMA. 1997 Sep 24;278(12):996-1000.
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.
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.
A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing.
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.
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.
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.
Physicians receiving free vaccine supplies report being less likely to refer children to public clinics for vaccinations.
对疫苗接种经济障碍的担忧促使儿童疫苗计划（VFC）的出台，该计划为无保险、符合医疗补助条件或美国原住民或阿拉斯加原住民儿童的州提供免费疫苗。
了解经济因素对医生将儿童转介至公共疫苗诊所进行免疫接种可能性的影响，并评估VFC计划。
1995年由经过培训的人员使用计算机辅助电话访谈进行了一项标准化调查。
对美国各地从事门诊工作、年龄小于65岁的家庭医生、儿科医生和全科医生进行分层随机抽样。
根据儿童的保险状况和医生是否收到免费疫苗，将儿童转介至卫生部门进行疫苗接种的可能性。
在接受访谈的1769名医生中，1236名参与了调查。大多数受访者（66%）可能会将无保险儿童转介至卫生部门进行疫苗接种，而只有8%的受访者可能会将有疫苗接种保险的儿童转介过去。大多数（58%）医生报告称会根据保险状况进行差别转介。在从VFC计划或其他地方收到免费疫苗供应的医生中，44%可能会转介无保险儿童，而未收到免费疫苗的医生中这一比例为90%（P<0.001）。在回归分析中，收到免费疫苗供应占无保险儿童转介接种可能性差异的24%。
收到免费疫苗供应的医生报告称，将儿童转介至公共诊所进行疫苗接种的可能性较小。
