BACKGROUND:
Among the nearly seven million children currently uninsured, having a regular source for health care may be an important factor in reducing immunization disparities. More research is needed to assess the importance of health insurance and a usual source of health care.

OBJECTIVE:
To assess the extent to which two factors, health insurance or having a primary clinician for well-child care, influence childhood immunization status.

METHOD:
We used data from the health insurance supplement to the National Immunization Survey (NIS) conducted among US households with children aged 19 to 35 months. Children were UTD if they had 4+ doses diphtheria and tetanus toxoids and pertussis vaccine, 3+ doses of any poliovirus vaccine, 1+ doses measles-containing vaccine, and 3+ doses Haemophilus Influenzae type b vaccine. Multiple logistic regression was conducted to estimate adjusted odds ratios (OR).

RESULT:
The percent of children with health insurance and a regular clinician for well-child care differed by race/ethnicity (whites, 59%, blacks, 43%, Hispanic 35%, other race 57%). After controlling for household income, maternal education, and metropolitan statistical area, children with a regular clinician reported an OR of 1.8 (CI 1.5-2.2) compared to those without a regular clinician. Children covered by health insurance reported an OR of 1.2 (CI 1.0-1.4) compared to those without health insurance.

CONCLUSION:
To improve childhood immunization levels, having a regular clinician for well-child care may be more important than having health insurance. This study reaffirms the important role of clinicians in promoting immunizations during well-child care visits.

LEARNING OBJECTIVES:
To learn the effects of a regular clinician and health insurance on childhood immunization levels.