Free Vaccination and Immunization Coverage of Uninsured Children: The Case of the Vaccines for Children Program in the United States



Objective : Vaccines against contagious diseases have strong positive externalities as immunization protects not just the immunized but those around them. Out-of-pocket immunization costs are a common barrier to obtaining vaccines, especially for low-income families or those without health insurance in the United States. The Vaccines for Children (VFC) Program, initiated in October 1994, allows all uninsured children in the United States to receive free vaccinations. Despite its importance, few studies have focused on the effectiveness of this program. Using data from the National Immunization Survey (NIS) from 1995–1997 (N=51902), this study investigates how the introduction of this program affected the immunization coverage of uninsured children aged 19–35 months.

Results : Accounting for variation in a child’s exposure to the program, I found that providing free vaccination correlated with an increase in the uptake of the entire spectrum of recommended vaccines, which included hepatitis B (Hep b) vaccine added to the recommended immunization schedule at the time. Further, despite the introduction of the program, uninsured children continue to have low immunization coverage. These findings suggest that improving immunization coverage for uninsured children by only reducing out-of-pocket vaccination costs may be insufficient and other factors may still influence vaccination decisions.

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Additional File

Additional file 1: Appendix Table 1. Descriptive Statistics, March CPS (1993–1997).

Appendix Table 2. Estimation result for March CPS (1993–1997).