Executive Summary

Immunization is essential to disease prevention efforts in public health, but the nation’s immunization system faces financing challenges that are affecting the delivery of services. A 2000 report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000), pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including unpredictable federal funding levels, growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in coverage plans in the public and private health care sectors that create uncertainties regarding vaccine purchase and service delivery arrangements.

The report recommended renewing and strengthening the federal– state partnership at the heart of the national immunization system, as well as strategic investments in immunization efforts and closer collaboration between public and private health care systems. As a framework to guide these efforts, IOM identified six fundamental roles for the nation’s immunization system: (1) controlling and preventing infectious disease; (2) assuring vaccine purchase; (3) assuring service delivery; (4) sustaining and improving coverage levels; (5) conducting surveillance of immunization coverage and safety; and (6) implementing effective immunization finance policies and practices.

In January 2002, health officials, public health experts, health care



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Executive Summary Immunization is essential to disease prevention efforts in public health, but the nation’s immunization system faces financing challenges that are affecting the delivery of services. A 2000 report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000), pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including unpredictable federal funding levels, growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in coverage plans in the public and private health care sectors that create uncertainties regarding vaccine purchase and service delivery arrangements. The report recommended renewing and strengthening the federal– state partnership at the heart of the national immunization system, as well as strategic investments in immunization efforts and closer collaboration between public and private health care systems. As a framework to guide these efforts, IOM identified six fundamental roles for the nation’s immunization system: (1) controlling and preventing infectious disease; (2) assuring vaccine purchase; (3) assuring service delivery; (4) sustaining and improving coverage levels; (5) conducting surveillance of immunization coverage and safety; and (6) implementing effective immunization finance policies and practices. In January 2002, health officials, public health experts, health care

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providers, health plan representatives, health care purchasers, and community leaders met at the University of California at Los Angeles to explore the implications of the IOM findings and recommendations for California in general and for Los Angeles and San Diego County in particular. The one-day workshop was the third in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about challenges for immunization finance and future financing strategies for immunization activities and the public health infrastructure that supports those activities. This report of the Los Angeles workshop summarizes the findings of the IOM study, reviews progress in responding to the IOM recommendations at the federal level, and highlights continuing challenges in immunization finance for the nation and at the state and local levels in California. Progress in responding to the IOM recommendations includes increases in federal funding for immunization infrastructure grants, discussions with the states to define a formula for the distribution of those grant funds, and efforts to improve the measurement of immunization coverage. In California, efforts at the state and local levels have helped in achieving immunization coverage levels comparable to the national average. Aiding clinics and private providers in assessing the immunization status of their patients has helped improve coverage rates. For employers, providing coverage for immunizations and other preventive services can be a cost-effective investment that reduces absenteeism. But California, its communities, and its health care providers and health plans face important challenges. The economic downturn is expected to mean reductions in state and local funding for immunization services. There is concern that nationwide shortages of several vaccines may result in lower immunization coverage rates. The high cost of new vaccines and the increasing cost of older vaccines are having a major impact on state and local budgets and their vaccine purchasing power. The high cost of vaccines also results in serious financial risk for many private providers who depend on reimbursements to cover the cost of their vaccine purchases. Workshop participants also commented on the financial and administrative problems that arise because children enrolled in California’s Healthy Families Program are not eligible for federally funded vaccines available through the Vaccines for Children program. Immunization registries are a welcome development, but their use imposes a sometimes prohibitive administrative burden on private providers. Immunization rates among the privately insured might be adversely affected if employers adopt plans that provide lump-sum benefits for preventive care and allow employees to decide how to allocate those benefit dollars. Workshop participants encouraged efforts to find less burdensome

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methods to capture data for immunization registries and to move to a more comprehensive statewide system. To address concerns about both the shortages and the rising costs of vaccines, it will be important to explore the public policy tools available to create appropriate incentives for the production and distribution of vaccines. Also emphasized at the workshop is the special difficulty that public health and the immunization system face. These services can seem invisible when they work because people are not getting sick, but the public health system has suffered from neglect because of its invisibility. Leadership is needed to ensure that immunization issues remain visible and receive appropriate attention.