Published online November 30, 2009
PEDIATRICS Vol. 124 Supplement December 2009, pp. S507-S514 (doi:10.1542/peds.2009-1542J)

This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Google Scholar Articles by Smith, P. J. Articles by Rodewald, L. E. PubMed PubMed Citation Articles by Smith, P. J. Articles by Rodewald, L. E. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

SUPPLEMENT ARTICLE

Underinsurance and Pediatric Immunization Delivery in the United States

Philip J. Smith, PhD, Noelle-Angelique Molinari, PhD, Lance E. Rodewald, MD

Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

BACKGROUND: Underinsured children are covered by private health insurance that does not cover the cost of vaccines, are not entitled to receive publicly purchased vaccines at no cost through the Vaccines for Children (VFC) Program unless they receive doses at a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), may be referred by their primary care providers to health department clinics (HDCs) for vaccinations, and may have lower vaccination coverage for new and more expensive vaccines.

OBJECTIVES: To describe the estimated percentage of children in the U.S. who are underinsured, receive vaccine doses at HDCs, and are not VFC-entitled; and to evaluate the association between being underinsured, receiving vaccine doses at an HDC, and timely vaccination coverage.

METHODS: Subjects were 16621 19–35 month-old children sampled by the National Immunization Survey in 2007.

RESULTS: Of all 19–35 month-old children, an estimated 10.5% were underinsured; and an estimated 1.4% were underinsured, received doses at an HDC, and were not VFC-entitled. Compared to fully insured children, children who were underinsured and received doses at an HDC had significantly lower vaccination coverage for the varicella (81.5% vs. 87.7%, p < 0.05) and PCV7 (55.1% vs. 75.9%, p < 0.05) vaccines.

CONCLUSIONS: Children who were underinsured and received doses at HDCs were found to have lower estimated timely vaccination coverage for recently recommended vaccines and more expensive varicella and PCV7 vaccines. To adequately vaccinate these children at HDCs, states require stable funding to pay for vaccines as the number of new and more expensive vaccines grows.

---

Key Words: immunization • financing

Abbreviations: VFC—Vaccines for Children • MSA—metropolitan statistical area • RHC—rural health center • FQHC—federally qualified health center • NIS—National Immunization Survey • DTaP—diphtheria-tetanus-acellular pertussis • PCV7—heptavalent pneumococcal conjugate vaccine • MMR—measles-mumps-rubella • Hib—Haemophilus influenzae type b • CI—confidence interval • HDC—health department clinic

---

Accepted Aug 25, 2008.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. K. Shen, J. Hunsaker, J. A. Gazmararian, M. C. Lindley, and G. S. Birkhead Role of Health Insurance in Financing Vaccinations for Children and Adolescents in the United States Pediatrics, December 1, 2009; 124(Supplement_5): S522 - S531. [Abstract] [Full Text] [PDF]

				M. C. Lindley, A. K. Shen, W. A. Orenstein, L. E. Rodewald, and G. S. Birkhead Financing the Delivery of Vaccines to Children and Adolescents: Challenges to the Current System Pediatrics, December 1, 2009; 124(Supplement_5): S548 - S557. [Abstract] [Full Text] [PDF]