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Suggested Citation:"Final Observations." Institute of Medicine. 2002. Setting the Course: A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10276.
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Final Observations

Immunization programs, like so many preventive health services, face the dilemma of being least noticeable when they are most successful: children and adults are not ill and do not require treatment because they have received appropriate immunizations. Achieving and sustaining that success requires a continuing investment of resources. Not making that investment and allowing immunization rates to decline creates the potential for serious disease outbreaks. But support for a continuing immunization effort can weaken if the need does not seem urgent and competing health care priorities claim more attention. Calling the Shots provides analysis and recommendations that can be used to inform legislators and other public officials about the key roles of the nation’s immunization system and the level of public funding that must be maintained to ensure that the system operates effectively.

The workshop highlighted several challenges facing immunization efforts. The recent introduction of a new and substantially more costly pediatric vaccine has altered some elements of the economic analysis in Calling the Shots. Growing concerns are emerging over the burden of vaccine costs among families, health care providers and health plans, and state and local health departments. Vaccine safety issues are receiving more attention and require greater effort to dispel rumors and to calibrate potential risks. Children and adults in low-income families continue to have lower immunization rates than the more affluent and often face an unstable health care services environment because of turnover among providers and health plans. Immunization registries promise access to

Suggested Citation:"Final Observations." Institute of Medicine. 2002. Setting the Course: A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10276.
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detailed data needed to stimulate and guide improvement efforts, but they are proving costly to operate and are not yet complete enough for many planned applications. Increasing public health resources in the wake of health care reform remains a challenging task.

There were also encouraging signs. With appropriate data and information tools, health care plans and individual providers are able to improve immunization rates among their pediatric and adult patients. The health care system is finding that new partners, such as pharmacists, can help meet adult immunization needs. Communities and health departments are ready to respond when pockets of need are identified. New strategies and partnerships are emerging to combine resources within the public and private sectors in ways that are flexible enough to address each community’s needs.

Workshop participants were optimistic that even if society’s continuing and significant problems such as poverty, inequity, and instability in the health care system could not be resolved, opportunities could be found to act on immunization needs. They noted that while federal assistance needs to be reliable and adequate to support local efforts, states and metropolitan areas also have important roles to play in strengthening the national immunization partnership. Creative approaches will be necessary to address persistent needs, to assure access to services while reducing reliance upon public resources, and to design new approaches that can use information resources efficiently. Strategies that persuade private health plans and providers to assume responsibility for achieving high coverage rates within the communities that they serve will be especially important in reaching national immunization goals for both children and adults.

Suggested Citation:"Final Observations." Institute of Medicine. 2002. Setting the Course: A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10276.
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Page 30
Suggested Citation:"Final Observations." Institute of Medicine. 2002. Setting the Course: A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop. Washington, DC: The National Academies Press. doi: 10.17226/10276.
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The federal and state partnership in supporting immunization programs that benefit the general population evolved over the last half of the 20th century from a simple cost-sharing arrangement for vaccine purchase for disadvantaged children to a more complicated mix of programs, health care coverage benefits, and public-private partnerships. The mix of financial arrangements that support immunization efforts was the subject of a study by the Institute of Medicine, resulting in the publication of the report Calling the Shots. In June 2001, a group of 50 health officials, public health experts, health care providers, health plan representatives, and community leaders met at the University of Illinois in Chicago to explore the implications of the IOM findings and recommendations for the states of Illinois and Michigan. The one-day workshop was the first in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about future financing strategies for the public health infrastructure that supports immunization efforts.

This report of the Chicago workshop summarizes the findings of the IOM study and reviews the challenges that remain in establishing a reliable financial base for the U.S. immunization system. The report high-lights strategies presented by workshop speakers and discussants for achieving immunization goals, including increases in state and federal public health budgets, the addition of quality improvement measures in health plans, performance-based contracting, public policy actions, and the creation of public-private partnerships.

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