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Exploring the impact of reimbursement ratios on willingness to vaccinate: A mixed-effects modeling approach using

Linbo Xie1,2, Jie Xing3,4, Mengsha Yan1,2

  • 1Vanke School of Public Health, Tsinghua University, Beijing, China.

Human Vaccines & Immunotherapeutics
|March 3, 2026
PubMed

Insights

Vaccine cost significantly impacts parental willingness to vaccinate children under six in China. Understanding cost sensitivity can improve childhood immunization coverage for crucial self-paid vaccines.

Area of Science:

  • Public Health
  • Epidemiology
  • Health Economics

Background:

  • Vaccination is a cornerstone of disease prevention, yet uptake of self-paid vaccines like EV71, varicella, influenza, and DTaP-IPV-Hib is suboptimal in young Chinese children.
  • Identifying factors influencing vaccine acceptance is crucial for enhancing public health strategies.

Purpose of the Study:

  • To investigate the determinants of willingness to vaccinate (WTV) for self-paid vaccines among children under six in China.
  • To analyze the relationship between vaccine cost and WTV, and identify population segments with varying cost sensitivity.

Main Methods:

  • Structured-questionnaire surveys were administered to 2212 households in Hangzhou with children under six.
  • Multiple regression and mixed-effect models were used to identify WTV determinants and cost-WTV correlations.
  • Unsupervised clustering segmented the population based on cost sensitivity.

Main Results:

  • Vaccine cost emerged as a primary determinant influencing WTV for self-paid vaccines.
  • Four distinct groups based on cost sensitivity were identified.
  • Families with a single child, children aged 1-3 years, highly educated parents, and higher socioeconomic status showed higher WTV.

Conclusions:

  • Vaccine cost is a critical barrier to uptake for self-paid vaccines in young children.
  • Targeted strategies addressing cost concerns and leveraging demographic factors can enhance vaccine uptake.
  • Improving immunization coverage for essential vaccines is vital for child health in China.

Keywords:
Childhood immunizationmachine learningmixed-effect modelself-paid vaccinesvaccine hesitancywillingness to vaccinate

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