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Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially o...

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Autores principales: Moon, Daseul, Kim, Saerom, Kim, Myoung-Hee, Jeong, Dawoon, Choi, Hongjo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599130/
https://www.ncbi.nlm.nih.gov/pubmed/34805079
http://dx.doi.org/10.3389/fpubh.2021.769176
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author Moon, Daseul
Kim, Saerom
Kim, Myoung-Hee
Jeong, Dawoon
Choi, Hongjo
author_facet Moon, Daseul
Kim, Saerom
Kim, Myoung-Hee
Jeong, Dawoon
Choi, Hongjo
author_sort Moon, Daseul
collection PubMed
description The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.
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spelling pubmed-85991302021-11-19 Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea Moon, Daseul Kim, Saerom Kim, Myoung-Hee Jeong, Dawoon Choi, Hongjo Front Public Health Public Health The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality. Frontiers Media S.A. 2021-11-04 /pmc/articles/PMC8599130/ /pubmed/34805079 http://dx.doi.org/10.3389/fpubh.2021.769176 Text en Copyright © 2021 Moon, Kim, Kim, Jeong and Choi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Moon, Daseul
Kim, Saerom
Kim, Myoung-Hee
Jeong, Dawoon
Choi, Hongjo
Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title_full Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title_fullStr Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title_full_unstemmed Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title_short Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea
title_sort contracting out national immunization program does not improve vaccination rate nor socioeconomic inequality: a case study of seasonal influenza vaccination in south korea
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599130/
https://www.ncbi.nlm.nih.gov/pubmed/34805079
http://dx.doi.org/10.3389/fpubh.2021.769176
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