Vaccine Financing Provider Survey, Oregon 2008

Background:
The number and cost of recommended vaccines for children and adolescents has risen significantly in recent years. Anecdotal information suggests that practices are facing severe financial burdens and may consider ceasing immunization delivery.

Objectives:
To assess the impact of vaccine finance issues on Oregon provider practices

Methods:
The Oregon Immunization Program (OIP) conducted a survey to solicit practices' perspectives regarding financing issues affecting the delivery of immunizations to children. In May 2007, a survey was mailed certified receipt to 554 vaccine decision-makers at all VFC practices or ALERT Immunization Information System users. Chi-square analyses were used to identify bivariate associations and logistic regression was used to develop predictive models of practices' consideration of ceasing vaccine provision.

Results:
Overall response rate was 54% (299/554), with 90% representing VFC clinics. Respondents included doctors (35%), RNs (18%), office administrators (17%) and MAs (11%). Respondents identified reimbursement by health plans (77%) and vaccine costs (75%) as challenges to service. To address these challenges, respondents suggested expanding Oregon's billables project to private providers, state general funds support for vaccine for under-insured patients, and tax incentives. In bivariate analysis, consideration to stop vaccinating was significantly associated with practice size and type, VFC participation, and clinician involvement in vaccine purchase decisions. In a multivariate model, only non-VFC participating providers were significantly more likely to report consideration of stopping privately funded vaccinations (p=.029, AOR= .368).

Conclusions:
Vaccine financing is an important issue to Oregon's vaccine providers; Respondents were unclear about how to resolve the problem. OIP will continue to use results to inform program policy, but it is clear that maintaining VFC enrollment is critical to ensuring access among Oregon's children.