costs of integrating all vaccines recommended for widespread use into their basic health care package. Private health plans should also be expected to bear at least some of the costs of “catch-up” conditions following the licensing of new vaccines (e.g., coverage of hepatitis B vaccine for older children who were too old to have been affected by the universal recommendations). Public health agencies should not be expected to supplement public or private health insurance plans except under short-term conditions, such as responding to emergency outbreaks or reducing disparities that result from “catch-up” conditions. Coordinated efforts, such as billing practices that allow public health clinics to be reimbursed for immunizations given to individuals who are covered by private health care plans, can help reduce the burden on public health agencies. Ideally, however, immunizations should be offered routinely in each plan participant’s medical home as an integrated part of primary care benefits.

Health plan providers should also be prepared to assess immunization coverage rates among their enrollees by using measures that can contribute to accurate community health profiles at the state and local levels. These efforts require independent oversight, however, to ensure that all groups are included in such assessments and that the measures used accurately reflect the immunization profile of those not currently enrolled in public and private health plans. Public health agencies can provide important measurement and audit services, such as assessment and feedback for private providers, as an investment in the quality of community health. These and other surveillance efforts should be supported by the national immunization partnership as a national health priority, with appropriate recognition of the issues of privacy and confidentiality.

SUMMARY RECOMMENDATIONS

Recommendation 1: The annual federal and state budgets for the purchase of childhood vaccines for public health providers appear to be adequate, but additions to the vaccine schedule are likely to increase the burden of effort within each state. Therefore, the committee recommends that CDC be required to notify Congress each year of the estimated cost impact of new vaccines that have been added to the immunization schedule so that these figures can be considered in reviewing the vaccine purchase and infrastructure budgets for the Section 317 program.

The committee believes the annual allocation of federal funds for the purchase of vaccines through the VFC program ($505 million for FY 2000) and the Section 317 state grant program ($162 million per year for



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