PEDIATRICS Vol. 90 No. 6 December 1992, pp. 1007
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Lack of Money—Barrier to Immunization

RON J. ANDERSON MD1

1 President and Chief Executive Officer, Chairman, Texas Board of Health, Parkland Memorial Hospital, 5201 Harry Hines Blvd, Dallas, TX 75235

In Reply.—

I reviewed the letter from Drs Zimmerman, Giebink, and Street concerning our article authored by Shulte et al (Pediatrics. 1991;87:204-207) which studied patterns of referral for immunization in Dallas County, Texas. We believe their comments are insightful and agree that financial barriers are a major reason that these children are referred. Their experience documents a financial gradient from the uninsured to the Medicaid to the fully insured population as concerns treatment or referral decisions from primary care physicians.