Abstract 764 General Pediatrics I Topic Plenary, Monday, 5/3

Background Local health department clinics (HDCs) serve as "safety net" providers for children and adolescents and deliver nearly 15% of preschool vaccinations.

Objectives (1) To describe types of health care provided, insurance mix, managed care participation, billing practices, and patient volume trends among HDCs providing immunization services, and (2) to determine differences in these factors between urban and rural clinics.

Design A national sample of local health departments was selected using probability proportionate to size. Within each, the manager of the largest HDC was interviewed by telephone about clinic characteristics and selected immunization practices. Population-weighted averages of clinic characteristics and practices were estimated using standard sample survey methods.

Results 166 clinic managers were surveyed, and 100% participation was obtained. 81% of clinics were located in urban settings, 19% in rural settings. For preschool children, 61% provided well child care, 27% acute illness care, 26% chronic illness care, and 27% after-hours telephone coverage. For adolescents, 45% provided well child care, 23% acute illness care, 24% chronic illness care, and 23% after-hours telephone coverage. 33% of pediatric patients served were enrolled in Medicaid, 27% had commercial insurance, and 40% were uninsured. Less than 20% of HDCs were managed care gatekeepers. HDCs billed Medicaid 62% of the time when immunizing referred Medicaid patients. Billing managed care organizations for immunizing referred children and adolescents was even less common (32% and 43%, respectively). The percentages of clinics reporting increases or decreases in children immunized during the past three years were similar (44%); 72% reported an increase in the number of adolescents immunized over the same time period. Type of care provided, insurance mix, managed care participation, billing practices, and patient volume trends did not differ statistically (all p>0.05) between urban and rural HDCs.

Conclusions The majority of HDCs do not provide comprehensive primary care for pediatric patients. Adolescent patient volume is increasing while preschool patient volume is stable. A majority of pediatric patients served are covered by Medicaid or commercial insurance, yet few clinics bill when immunizing referred patients. Managed care participation is also not a common source of revenue for HDCs. Implementation of billing systems and entering into managed care contracts may help to support the increased need for resources faced by HDCs.