nor does the use of primary care services ensure that children receive timely immunizations. Further steps will be needed to establish links between families and providers and to encourage providers to immunize all children for whom they are responsible.

Health care reform is also likely to reduce the delivery of personal health services by public health departments and shift those services to the private sector. This may not be the case, however, for special populations such as illegal immigrants, who may be hard reach. Public health departments will remain responsible for developing policy, assessing the need for individual and community health services, and assuring that those services are provided (IOM, 1988). With better information about a community's needs, health departments also are likely to assume an enhanced role in outreach and education. As private providers become the principal source of services such as immunization, they will play an increasingly important role in meeting the community 's public health needs. Private providers, especially in capitated health care plans, are also likely to become more accountable for the delivery of those services.


The committee found that the workshop presentations and discussions indicate that efforts to improve immunization rates for preschool children should focus on five specific concerns:

  • leadership for action on immunization;

  • accountability and responsibility for providing immunizations;

  • support for improving provider practices;

  • effective communication with families and the community; and

  • development of better information and more effective information tools.

The remainder of the report addresses these issues. For each topic, steps that could be taken to improve immunization services in the short term and in the longer term also are discussed.

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