Abstract
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.
Highlights
Coronavirus disease (COVID-19) vaccination is currently underway, and improving the vaccination rate is a key strategy for achieving herd immunity
We considered that a level change and slope change model would be appropriate to identify the impact of contracting out of the National Immunization Program (NIP), because the total number of hospitals providing free vaccination was immediately increased right after the policy change and the change could gradually change the health seeking behaviors of people [19]
3,94,284 were included in the final analysis after excluding participants in the 2015 survey (n = 63,141) and individuals who did not provide a response for immunization status (n = 1), marital status (n = 136), smoking status (n = 23), alcohol consumption status (n = 92), and diabetes mellitus (DM) status (n = 1,127)
Summary
Coronavirus disease (COVID-19) vaccination is currently underway, and improving the vaccination rate is a key strategy for achieving herd immunity. In Korea, majority of the population (97%) are covered by the National Health Insurance Services, while the most disadvantaged are covered by the Medical Aid Program. Improvement in physical and economic accessibility is achievable through policies guaranteeing free vaccination, as well as by securing enough medical institutions that can provide such a service within a reachable distance [6]. In Korea, the National Immunization Program (NIP) was initially carried out mostly by public medical institutions. The Korean government pursued a policy for expanding the NIP to include private medical institutions [7] COVID-19 vaccination was carried out in a similar manner: in the early stages, vaccination was carried out through most public medical institutions and was subsequently expanded through the NIP to include private medical institutions
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