registries are up-to-date, they can help maintain accurate immunization records for children who receive care from multiple sources. But the work-shop discussions made it clear that while the registries in Michigan and Illinois are progressing, they are not yet complete enough to be used for surveillance. Some children are not included and many providers, especially those in the private sector, are not submitting reports. Workshop participants noted that even when health plans agree to provide data, they may not have the tools to monitor or enforce submission of reports by individual providers. Michigan’s experience has also shown that the cost of operating a registry remains high beyond the start-up period.


Some of the concerns related to immunization finance—increasing vaccine costs and insurance benefits, for example—have already been reviewed. In addition, workshop participants expressed concern about the stability of state funding for immunization programs. Term limits are increasing the influx of new state legislators and legislative staff who may be unfamiliar with the potential seriousness of vaccine-preventable diseases and the complexities of health care finance. The importance of maintaining an effective immunization infrastructure and adequate supplies of vaccine can easily be overlooked when immunization rates are high and disease prevalence is low. There is also concern that growing attention to claims of potential risks from vaccine use may weaken legislative support for immunization programs.

Various financial disincentives were also noted. For individual providers, such disincentives result from the paperwork and delays in reimbursement as well as inadequate reimbursement for vaccine and vaccine administration. Financial disincentives can also arise from the administrative burden of programs such as VFC, which requires separate record-keeping 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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