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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