Introduction

Immunization is an essential public health tool for preventing serious illness and death from certain infectious diseases. In June 2000, the Institute of Medicine (IOM) report Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000) pointed to disturbing signs of instability in the nation’s immunization system, as well as in the public health infrastructure supporting it: growing financial burdens and operational complexities in the delivery of immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and an unsettled health insurance environment in both the public and private sectors that contributes to uncertainties regarding coverage for vaccines and immunization services.

The national immunization system is a partnership that relies on multiple and diverse relationships involving federal agencies and programs, health officials in state and local governments, health care providers, employers, insurers and health plans, vaccine manufacturers, and others in the private sector. The Centers for Disease Control and Prevention (CDC) requested that IOM undertake a special effort to reach these various groups as part of the dissemination activities for Calling the Shots. Three regional workshops and a national meeting are being held to review the findings and recommendations of the IOM report and to examine their implications for health care policy at state and local levels, the coverage of immunization benefits under private health plans, and the delivery and quality of heath care services, especially in disadvantaged communities.



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Introduction Immunization is an essential public health tool for preventing serious illness and death from certain infectious diseases. In June 2000, the Institute of Medicine (IOM) report Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000) pointed to disturbing signs of instability in the nation’s immunization system, as well as in the public health infrastructure supporting it: growing financial burdens and operational complexities in the delivery of immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and an unsettled health insurance environment in both the public and private sectors that contributes to uncertainties regarding coverage for vaccines and immunization services. The national immunization system is a partnership that relies on multiple and diverse relationships involving federal agencies and programs, health officials in state and local governments, health care providers, employers, insurers and health plans, vaccine manufacturers, and others in the private sector. The Centers for Disease Control and Prevention (CDC) requested that IOM undertake a special effort to reach these various groups as part of the dissemination activities for Calling the Shots. Three regional workshops and a national meeting are being held to review the findings and recommendations of the IOM report and to examine their implications for health care policy at state and local levels, the coverage of immunization benefits under private health plans, and the delivery and quality of heath care services, especially in disadvantaged communities.

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The IOM workshop discussions are designed to achieve the following goals: foster awareness of the conclusions and recommendations of Calling the Shots; strengthen interactions among public- and private-sector health officials to build consensus about immunization infrastructure initiatives, measurement approaches, and financing plans; and identify unresolved public health and health finance issues and concerns at the regional, state, and local levels that require further attention from public and private policy makers. The first of the three regional workshops, held in June 2001 in Chicago, Illinois, examined statewide concerns in Illinois and Michigan and the challenges facing the cities of Chicago and Detroit in sustaining efforts to improve immunization rates (IOM, 2002a). A second workshop was held in October 2001 in Austin, Texas. Discussions at that meeting highlighted concerns of private providers throughout the state and opportunities for greater public–private collaboration in financing vaccine purchase and service delivery (IOM, 2002b). This report summarizes the discussions of the third regional dissemination workshop, which examined immunization issues in California, with a special focus on Los Angeles and San Diego counties. The meeting, which was held in January 2002 at the University of California at Los Angeles (UCLA), was organized by IOM in collaboration with the School of Public Health at UCLA and the Los Angeles County Health Department. Participants included state and local health officials; health care providers; representatives of health plans and corporate health care purchasers; faculty from UCLA and the University of California at San Diego; community leaders; staff from CDC; consultants and other contributors to Calling the Shots; and members and staff of the IOM planning committee. (See Appendixes A, B, and C for the workshop agenda, a list of participants, and addresses of Internet websites that pertain to the IOM report and the workshop discussions.)