Access to Infant Immunizations for Poor, Inner-City Families

What Is the Impact of Managed Care?

Published In: Journal of Health Care For the Poor and Underserved, v. 5, no. 2, 1994, p. 112-123

by David L. Wood, Neal Halfon, Cathy D. Sherbourne, Mark Grabowsky

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

Looks at the impact of managed care in terms of access to infant immunizations for poor, inner-city families. The study was based upon a survey of 867 families in two inner-city areas of Los Angeles. It assessed the relationship between insurance type, source of care, and access to immunization services. Compared to children in public health clinics, those receiving care in private physicians' offices or health maintenance organizations had odds of being up-to-date on immunizations of 0.43 and 0.24, respectively. These findings led the authors of the study to conclude that in the absence of meaningful financial incentives to encourage private physicians and HMOs to provide immunizations to inner-city children, managed care is unlikely to improve immunization rates among this vulnerable population. Enrolling children in managed care plans, such as is being contemplated in California for half its Medicaid population, will not have the expected impact of increasing immunizations unless attention is paid to this issue.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.