Setting the Course A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop (2002) / Chapter Skim
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Challenges Facing the Immunization System
Challenges Facing the Immunization System
Pages 10-24
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From page 10... ...
Some of these demands include sustaining current rates of coverage with the addition of new and more expensive vaccines to the immunization schedule, an increase in the number of people to serve as a result of recommendations for adolescent and adult vaccination, and changes in the health care delivery system in general and immunization services in particular that can affect the availability and affordability of vaccines in the private sector. The workshop discussions covered several broad national concerns about the immunization system as well as issues of specific concern at the state level in Illinois and Michigan and at the local level in Chicago and Detroit.
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From page 11... ...
The reduced burden of illness represents significant improvements in both mortality rates and the quality of life in each community, as well as cost savings for local and state health agencies, since public hospitals no longer need to care for patients affected by vaccine-preventable disease. Workshop participants noted that achieving high levels of immunization coverage not only offers immediate protection of vaccinated individuals but also conveys long-term benefits by reducing the reservoir of disease and hence the number of future cases in the general population.
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From page 12... ...
# 44,665 in 1989 1995 1996 1997 1998 1999 2000 2001 Year of Report Licensed in U.S., 1995 FIGURE 2 Impact of immunization on disease in Michigan. SOURCE: Gillian Stoltman, Michigan Department of Community Health.
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From page 13... ...
Children in families of undocumented immigrants may be at special risk and pose an added risk to the community if they are underimmunized and their families are apprehensive about using health care services. William Schaffner from Vanderbilt University contrasted the relative success in preventing disease in children with adults' continued high rates of illness and death related to vaccine-preventable diseases, including influenza, pneumococcal disease, and hepatitis B
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From page 14... ...
ASSURING VACCINE PURCHASE Immunization programs are possible because of the availability of highly effective vaccines. The Vaccines for Children program distributes federally purchased vaccines directly to health care providers for use in immunizing children who depend on Medicaid for their health care services or who are uninsured or qualify under additional categories of eligibility.
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From page 15... ...
Workshop participants affirmed the importance of the IOM recommendation for regular evaluation of vaccine purchase budgets. Gillian Stoltman from the Michigan Department of Community Health presented trend data that illustrated the recent impact of the cost of the new pneumococcal conjugate vaccine, which was added to the recommended immunization schedule in 2000 (after the IOM committee concluded its deliberations; see Figure 3~.
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From page 16... ...
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From page 17... ...
Finally, some private health care providers are reluctant to participate in the VFC program, even though they provide primary care to eligible children. The paperwork requirements associated with the VFC purchase plan have discouraged some providers from offering the vaccines to disadvantaged children as part of their primary care in a "medical home." These providers continue to send children to the local public clinic, creating a steady demand for immunization services in a public health setting.
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From page 18... ...
For older children, adolescents, and adults under age 65, private health insurance benefits for immunization services vary in scope and are often more limited than those for the youngest children. For example, one major automobile manufacturer reportedly offers a health insurance plan that covers immunization only up to age 5.
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From page 19... ...
One workshop speaker commented that even though the health benefits of the new pneumococcal conjugate vaccine for children had been evident for several months before the formal ACIP recommendation for its use, several health plans in Michigan still required several months following the ACIP action to resolve coverage questions. Market factors also influence decisions about health insurance benefits packages.
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From page 20... ...
Children in urban areas also may have problems obtaining the immunization services for which they are eligible because of confusion and instability in Medicaid managed care services. Workshop participants from Michigan and Detroit, for example, reported that confusion on the part of parents and Medicaid providers about coverage and eligibility for Medicaid and VFC services results in referrals of some children to public clinics for immunizations covered by VFC.
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From page 21... ...
Burden on Public-Sector Programs The experience in Michigan and Detroit illustrates the continuing demand for immunization services from health department clinics, as either a primary or safety net source for such services. Although this evidence of the public's trust in these clinics was welcome, health department clinics generally have limited resources and lack infrastructure for coordinating their services with other immunization providers or for seeking reimbursement from health plans for services covered under Medicaid capitation rates or VFC.
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From page 22... ...
fulie Morita from the Chicago Department of Health described the department's response to the Englewood study, highlighting efforts to inform the community and local health care providers about the study results. These discussions focused on identifying both short- and longterm steps intended to improve immunization coverage.
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From page 23... ...
Adult Immunization In contrast to the multiple programs designed to improve pediatric immunization rates, relatively few systematic efforts exist to address low adult immunization levels. In addition to the limited use of Section 317 funds to purchase vaccine for adults and the limited insurance coverage for adult immunization (noted above)
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From page 24... ...
Financial disincentives can also arise from the administrative burden of programs such as VFC, which requires separate recordkeeping for VFC and non-VFC vaccine supplies and services. Similarly, if Medicaid capitation rates are judged too low, some private health plans may choose not to bid on or continue Medicaid contracts, potentially limiting and disrupting the availability of immunization services for Medicaid enrollees.
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