Background: Universal purchase (UP), the state purchase of vaccines for all children regardless of income or insurance status, is one strategy to lower families' health care expenses. North Carolina implemented a UP program in 1994.

Objective: To explore the financial impact of UP on families with different types of insurance coverage for immunizations and well-child care.

Methods: Pediatricians and family physicians were surveyed to collect data on patient charges. Data from North Carolina pediatricians were used to estimate families' out-of-pocket expenses for preventive care through the first two years of a child's life, based on several scenarios related to insurance status.

Results: Overall, private-sector immunization charges decreased but well-child visit charges increased since the introduction of UP in North Carolina. Fully insured, underinsured, and uninsured families who previously received all services in the private-sector had decreased out-of-pocket expenses as a result of UP. However, for families who previously received well-child visits in the private-sector but immunizations from public clinics, choosing to remain in the private-sector “medical home” for immunizations after implementation of UP resulted in increased out-of-pocket expenses.

Conclusions: For many families, UP is effective in reducing out-of-pocket expenses for preventive care. UP does not, however, completely eliminate cost as a barrier to immunization, nor does it enable all children to remain in their medical homes. As such, it should be seen as only one component of a broader strategy to improve immunization delivery.