Recorded presentation

Andrew Racine, MD, PhD, Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore and NBER, 365 Fifth Avenue, 5th Floor, New York, NY 10016, (212)817-7960, aracine@montefiore.org and Ted Joyce, PhD, Baruch College and NBER, 365 Fifth Avenue, 5th Floor, New York, NY 10016.

Research Objective: To test whether SCHIP is associated with differential gains in age-appropriate immunization rates among poor and near-poor children relative to their non-poor counterparts and whether the uptake of new vaccines among poor and near-poor children was faster than would have been observed in the absence of SCHIP.

Study Design: We use eight years of data (1995-2002) from the recently released National Immunization Survey (NIS) to associate changes in immunization with implementation of SCHIP. The NIS has information on vaccine receipt, characteristics of the providers as well as social and economic measures of the household. Specifically, we compare changes in up-to-date immunization status before and after implementation of SCHIP in all 50 states and the District of Columbia stratified by poor, near-poor and non-poor children. If SCHIP has improved access to, and the quality of pediatric care, then we would expect to observe relative improvements in up-to-date immunization status among poor and near-poor children relative to non-poor.

Population Studied: National Immunization Survey (NIS) is a population-based survey of more than 30,000 households per year with children between 19 and 35 months of age. The NIS is conducted in all 50 states and the District of Columbia.

Principal Findings: We show that the probability that a poor or near-poor child is up to date for the 4:3:1:3:3 vaccine series increased approximately 10 percentage points after SCHIP. However, we observe a similar increase for non-poor children. As to new vaccines, we demonstrate that uptake of the varicella vaccine increases between 8 and 19 percentage points more among poor and near-poor relative to non-poor children after implementation of SCHIP. However, we present evidence that the differential gains by poor and near-poor children are related to the diffusion of new vaccines and not specifically to SCHIP.

Conclusion: Our results suggest that the availability of publicly provided health insurance for poor and near-poor children may be a necessary but not a sufficient condition to narrow the income gradient for immunizations.

Implications for Policy, Delivery or Practice: A fully-immunized child now receives upwards of 19 shots over eight visits in the first two years of life. To insure that poor and near-poor children do not fall behind, we need to go beyond policies directed at ability to pay and to concentrate perhaps on the continuity of care, computerized registries and parent reminder systems.

Learning Objectives:

• To understand the effects of public insurance expansions on early childhood vaccinations.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation