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Introduction
Pages 18-53

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From page 18...
... . We propose a national strategy to guide the federal and state partnership in supporting immunization efforts, improving coordination, and allocating costs between the public and private health care sectors.
From page 19...
... within private and public systems of personal health care services; and (3) the development of a public health infrastructure that can monitor disease patterns and improve immunization coverage rates, especially among vulnerable populations.
From page 21...
... Finally, while vaccine purchase costs have increased in both the public and private sectors, it is important to note that the public sector now bears a larger share of the cost of vaccines. The public-sector discount declined from 75 percent of catalog prices in 1987 to 50 percent in 1997 (Orenstein et al., 1999~.
From page 23...
... . On October 22, 1999, the Advisory Committee on Immunization Practices (ACIPJ recommended that Rotashield~ (RRV-TV)
From page 24...
... . Other costs, such as outreach, education, training, data collection, and surveillance of coverage rates and vaccine safety, are incurred by public health agencies (as discussed later in this chapter)
From page 25...
... Some health practices may also charge separate fees for the production and copying of immunization records, fees that are commonly not reimbursed by health plans. Moreover, the shift in many states from fee-for-service to managed care plans (which has occurred swiftly within Medicaid)
From page 26...
... 1998, the VFC program, which provides federally financed vaccines for four categories of disadvantaged children, spent $437 million in federal funds for vaccines and operational costs; Medicaid program expenditures for immunization in this same year were an additional $127 million, $70 million of which was federal. In addition, CDC provided $418 million in support of vaccine purchase for the states, financial assistance for state immunization programs, and CDC program TABLE 1-4 Total Federal Immunization Funding, FY 1999 ($ in millions)
From page 29...
... that support immunization efforts. Limitations of Current Efforts The current levels of public and private investment in immunization efforts have been successful in controlling infectious diseases and improving levels of immunization coverage.
From page 30...
... A recent and troubling development is that coverage levels in a few cities (most notably Houston and Chicago) have begun to decline TABLE 1-5 Estimated Vaccination Coverage of 4 3 1 3a Among Children 19-35 Months of Age by Selected Geographic AreasUnited States, National Immunization Survey, 1995-1999 1995 1996 1997 Geographic Rest of Geographic Rest of Geograpt Area Area States Area States Area Jefferson County, AL 85 (+ 4.9)
From page 31...
... Given these gaps, the National Vaccine Advisory Committee (NVAC) has stated that a com .
From page 32...
... Budgetary shifts in the support for vaccine purchase and immunization programs have created a climate of uncertainty and instability within the states that discourages the implementation of preventive interventions to improve immunization coverage rates. As a result, states report that they have reduced efforts to link immunization services with other health and social service programs, such as the Women, Infants, and Children (WIC)
From page 33...
... 3. What are current and future funding requirements for immunization activities, and how can those requirements be met through a combination of state funding, federal Section 317 immunization grant funding, and funding available through SCHIP?
From page 34...
... (NVAC, 1991~. The persistence of low immunization coverage rates for routine vaccines (especially measles, rubella, diphtheria, and pertussis)
From page 36...
... It is time, therefore, for a strategic vision that can clarify the roles and responsibilities of state and federal agencies in achieving national immunization goals and provide the resources to support this effort. Role of the Section 317 Program In the first few decades of the formation of the national immunization partnership, the federal role was limited primarily to the purchase of vaccines that would allow the states to meet the needs of disadvantaged children (see Appendix B for a chronology of the U.S.
From page 37...
... . VFC is a vaccine purchase program designed to encourage the provision of immunizations to children within a "medical home" that provides basic primary care services.
From page 38...
... During the first half of the 1990s, the budget for Section 317 state immunization infrastructure grants grew substantially, but funding levels for state infrastructure awards have declined significantly in the past 4 years (see Figures 1-2 and 1-3~. Since the federal government now relies heavily on the private sector to administer programs such as VFC and SCHIP to improve the quality of health care for disadvantaged children, the potential for overlap and duplication of effort between these programs and Section 317 awards may exist and requires consideration and oversight.
From page 39...
... Assessment, Assurance, and Policy Development in the National Immunization Strategy When infectious disease was widespread during the first half of the 20th century, vaccine services generally consisted of community-based, stand-alone, self-contained efforts designed to achieve universal coverage in schools or other community settings within a relatively short period of time. Local health agencies often funded and publicized programs such as "Shots on Sunday" or "Back-to-School Shots." As these programs expanded
From page 40...
... Investments were often financed through emergency appropriation bills or vaccine purchase budgets that drew strong bipartisan support in the interest of controlling outbreaks of infectious disease. Public health clinics have traditionally provided free vaccines for disadvantaged families and are commonly the first line of defense during outbreaks or epidemics.
From page 41...
... Completion of an immunization series requires multiple interactions with providers over a lengthy period of time, and determining the immunization status of an individual at any particular time can be difficult for both clients and health professionals. More than half of all infants and children aged 0 through 5, for example, are covered by private health insurance, but not all health plans include immunization coverage.8 In contrast, all Medicaid health plans include comprehensive immunization benefits within the Early and Periodic Screening, Diagnosis and Treatment program (as described in Chapter 3~.
From page 43...
... Most important, the presence or absence of private health care services (including insurance coverage and benefits that encompass immunization services for children, adolescents, and adults at reasonable cost) influences the burden of effort required within the public sector to assure access to vaccines recommended for widespread use.
From page 44...
... 44 ~ ~ ° s ~ In Cot (d Hi-— E /"'< / s Cd I o Q \ ° C E Ct o o Zoo l ~ Jig o o E o o \ mm \ 2` E ~ o >m 'm ~ E Cat 'a E `5 of/ ~ ~ o E ~ )
From page 46...
... In conducting the study, we gave particular attention to the responsibilities of federal and state health agencies and the burden of effort required to support each of the above roles in an integrated manner. Figure 1-6 displays these roles as components of the national immunization partnership.
From page 47...
... First, each encompasses an array of specific programs and functions (see Figure 1-7~. Programs to improve immunization coverage rates, for example, include interventions to reduce vaccine costs, expand access to immunization services, address missed opportunities, improve documentation of immunization status, increase community demand for vaccinations, and establish requirements and incentives for providers.
From page 48...
... VFC administration in private sector Public health clinics Maternal and Child Health/WlC/community health clinics National Notifiable Disease Surveillance System Public health laboratories State epidemiology centers Emergency vaccination programs Educational programs FIGURE 1-7 Six roles of the national immunization system, broken down by role (continues on next page)
From page 49...
... Addressing missed opportunities · Improving awareness and documentation of immunization status National Immunization Survey Retrospective school entry surveys Special area/population surveys CASA surveys · Managed care/HEDIS surveys Registries Vaccine Adverse Event Reporting System Private-sector roles and responsibilities Public-sector roles and responsibilities Use of outcome m easu res/pe rfo rm ance standards Linkages among health plans and immunization programs Strategic investments in infrastructure Funding levels
From page 50...
... Third, the level of resources required for each state to perform each role effectively is not well understood, since immunization coverage rates are influenced by a broad mix of factors that include national health trends, local demographics and social conditions, and public and private health finance patterns. For example, some states (e.g., Alabama)
From page 51...
... Committee members and staff met frequently with state health officials over the course of the studying and received materials pertaining to state and private immunization efforts from the American Academy of Pediatrics, the American Association of Health Plans, the Association of Maternal and Child Health Programs, the Association of State and Territorial Health Officers, the Health Insurance Association of America, the National Association of City and County Health Officers, and the National Association of WIC Directors. Additional materials regarding state roles in public health were provided by the National Governors' Association and the National Conference of State Legislatures.
From page 52...
... immunization system differs from that of 1990 and earlier decades, and identifies emerging challenges and scientific opportunities in the decades ahead that have finance implications for the national immunization system. Chapters 3, 4, and 5 address the six roles of the national immunization system: vaccine purchase and service delivery (Chapter 3~; infectious disease prevention and control, surveillance of vaccine coverage and safety, and efforts to improve and sustain coverage rates (Chapter 4~; and immunization finance policies and practices (Chapter 5~.
From page 53...
... . In addition, the following state and local health officers presented testimony at meetings of the IOM committee: David Johnson, Deputy Director and Chief Medical Executive, Michigan Department of Community Health, Lansing; Donald Williamson, State Health Officer, Alabama Department of Public Health, Montgomery; Christine Grant, Acting Commissioner, New Jersey Department of Health and Social Services, Trenton; Steven Friedman, Assistant Commissioner, New York City Health Department; Eleni Sfakianaki, Medical Executive Director, Dade County Health Department, Miami, Florida; Akiko Kimura, Medical Director, Immunization Program, Los Angeles, California; Babatunde A


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