Vaccination Programs: Monetary Sanction Policies
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether monetary sanction policies increase vaccination rates among children in families receiving government assistance. The finding is based on the small number of studies; differences in the type of sanction policies evaluated; inconsistent results on vaccination rates; and limited information on potential harms of these policies.
The full CPSTF Finding and Rationale Statement and supporting documents for Vaccination Programs: Monetary Sanction Policies are available in The Community Guide Collection on CDC Stacks.
Intervention
Monetary sanction policies deny government assistance to families whose children are not up to date with vaccinations. Penalties may be a reduction in financial assistance or complete loss of benefits, and are only applied after families receive one or more warnings. Policies may be established by legislative action or agency dictate.
About The Systematic Review
The CPSTF finding is based on evidence from a Community Guide systematic review completed in 2011 (2 studies, search period January 1980-November 2009). A more recent search (2009-February 2012) did not identify new studies.
Study Characteristics
- Both studies from United States and evaluated state monetary sanction policies for families receiving Aid to Families with Dependent Children (AFDC)
- Both studies used randomized controlled trials
- One study conducted over two years, one over three years
Summary of Results
Two studies were included.
- One study (1,324 young children in Maryland AFDC program) showed 0.7 percentage point decrease in vaccination rates
- Another study (2,500 families in Georgia AFDC program) reported 11.8 percentage point increase in vaccination rates
Summary of Economic Evidence
An economic review was not conducted because CPSTF did not have enough information to determine if the intervention works.
Applicability
Applicability was not assessed because CPSTF did not have enough information to determine if the intervention works.
Evidence Gaps
- Are there circumstances when monetary sanction policies are effective and beneficial?
Implementation Considerations and Resources
It has been suggested that monetary sanction policies may increase clients’ contact with healthcare providers which may increase receipt of other preventive services. However, the Maryland study found no difference in receipt of well-child visits.
Potential harms include loss of financial support for families in need, whether through sanction, program drop-out, or reductions in applications for assistance.
Monetary sanction policies may negatively affect other program activities and interactions between program staff and families in need of assistance.
Agencies might not adopt or enforce these policies because of concerns about harms to families.