Background: Universal purchase (UP) of vaccines is a state program in which providers are supplied with free vaccines for all children, and patient charges are limited to administration fees only. North Carolina instituted UP in 1994.

Objective: To explore the effects of UP on immunization revenue for North Carolina physicians.

Methods: Pediatricians and family physicians (N=2163) were surveyed in 1995 to collect data on patient charges for various immunizations and well-child visits, and physician perceptions of the effects of state immunization programs on their practice. Results were compared with a 1993 baseline study. A model was devised to simulate the net effect of the UP program on immunization revenue for North Carolina pediatricians.

Results: Patient charges for immunization decreased substantially in North Carolina, but 60% of North Carolina physicians increased their charges for well-child visits. Following the schedule of 9 well-child visits in the first two years of life recommended by the American Academy of Pediatrics, the overall increase in well-child visit charges for North Carolina pediatricians was $36.09 per child. Calculations in the model reflect an overall $196.48 decrease in patient charges for immunization from 1993 to 1995; almost all of this decrease was due to elimination of provider vaccine cost under the new UP program. The average decrease in physicians' total administration fee (net revenue) was only $2.92 per patient.

Conclusions: Although pediatricians recognized a dramatic decrease in gross immunization receipts under the North Carolina UP program, the average decrease in net revenue was minimal. However, any additional administrative burden required for UP participation could potentially affect that revenue margin.