Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1999 February; 89(2): 171–175.
PMCID: PMC1508536

The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.


OBJECTIVES: The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback. METHODS: Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. RESULTS: The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low. CONCLUSIONS: Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kouides RW, Lewis B, Bennett NM, Bell KM, Barker WH, Black ER, Cappuccio JD, Raubertas RF, LaForce FM. A performance-based incentive program for influenza immunization in the elderly. Am J Prev Med. 1993 Jul-Aug;9(4):250–255. [PubMed]
  • Fairbrother G, Friedman S, Hanson KL, Butts GC. Effect of the vaccines for children program on inner-city neighborhood physicians. Arch Pediatr Adolesc Med. 1997 Dec;151(12):1229–1235. [PubMed]
  • LeBaron CW, Chaney M, Baughman AL, Dini EF, Maes E, Dietz V, Bernier R. Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994. JAMA. 1997 Feb 26;277(8):631–635. [PubMed]
  • Wennberg JE, Blowers L, Parker R, Gittelsohn AM. Changes in tonsillectomy rates associated with feedback and review. Pediatrics. 1977 Jun;59(6):821–826. [PubMed]
  • Mugford M, Banfield P, O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. [PMC free article] [PubMed]
  • Morrow RW, Gooding AD, Clark C. Improving physicians' preventive health care behavior through peer review and financial incentives. Arch Fam Med. 1995 Feb;4(2):165–169. [PubMed]
  • Harr DS, Balas A. Managing physician practice patterns: providing information feedback to improve quality care & reduce cost. Mo Med. 1994 Mar;91(3):138–139. [PubMed]
  • Buntinx F, Winkens R, Grol R, Knottnerus JA. Influencing diagnostic and preventive performance in ambulatory care by feedback and reminders. A review. Fam Pract. 1993 Jun;10(2):219–228. [PubMed]
  • Fairbrother G, Friedman S, DuMont KA, Lobach KS. Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children. Pediatrics. 1996 Jun;97(6 Pt 1):785–790. [PubMed]
  • Fairbrother G, DuMont KA, Friedman S, Lobach KS. New York City physicians serving high volumes of Medicaid children: who are they and how do they practice? Inquiry. 1995 Fall;32(3):345–352. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...