of administering an injection, a practice must also see to ordering and managing separate inventories of VFC and non-VFC vaccine, monitoring refrigeration temperatures each day, maintaining and reviewing patient records on immunizations, following up missed immunization appointments, and submitting claims and reports to multiple health plans and to the immunization registry. Periodic reviews of medical records by the health department and health plans also place demands on physician and staff time. Dr. Kieu estimated that medical practices face at least one such review each month.

The burdens of participating in an immunization registry are a particular concern. Data that must be entered in patient records and insurance claims must be entered again for a registry. Dr. Kieu suggested that the development of more efficient data entry techniques would help encourage registry participation by private providers. She mentioned possibilities such as bar code scanning to capture vaccine dose and lot information and web-based data entry systems.

Dr. Kieu took the position that in delivering immunization services, private providers should not face financial risk for performing a public health function. She outlined several steps that might be taken to reduce this risk for California physicians. A statewide registry would provide more accurate information about children’s immunization status, but providers will need assistance in the form of new technology or financial support for administrative costs to meet the data entry demands. California has already responded to the financial problems that can be created when new vaccines are added to the immunization schedule, as happened with the addition of the pneumococcal conjugate vaccine. Legislation passed in January 2001 protects providers from financial hardship when new vaccines are introduced, but Dr. Kieu noted that some health plans were slow to provide the compensation called for by the new legislation.

Public purchase of vaccine for all publicly insured children or the establishment of reimbursements or billing ceilings that are adequate to cover vaccine costs would also aid providers. The California AAP chapter has proposed the creation of a VFC-like system for ordering and distributing vaccine for children enrolled in the state’s Healthy Families Program. Dr. Kieu cited an estimate that such a system would result in a cost savings to the state of $200 per child. With the differences in private insurance benefits, she also suggested that the state might mandate that the private insurers provide full coverage for immunization services.