budgetary decisions, as well as state contribution, programmatic, and reporting requirements. A small set of comparable measures that can harmonize the Health Plan Employer Data and Information Set (HEDIS) and the National Immunization Survey, for example, will allow federal and state agencies to monitor state need, capacity, and performance without imposing unnecessarily burdensome reporting efforts on the states that would restrict their ability to use federal funds productively in responding to local circumstances (Fairbrother and Freed, forthcoming). Such measures can also facilitate efforts by state and federal health officials to assess the quality of primary care health services within private-sector health plans, so that public health agencies can direct appropriate resources to areas in which private-sector plans do not have sufficient capacity to meet health care needs. Assessments of these rates should allow state and federal governments to monitor immunization levels and identify disparities in need, capacity, and performance over time and among regions, including small geographic areas and selected health plans (e.g., Medicaid, SCHIP, and private insurance).

The use of consistent immunization measures within the public and private sectors offers a valuable opportunity to conduct research on the factors that can contribute to disparities in coverage rates within different types of health plans. Finally, immunization measures offer benefit not only for immunization efforts, but also for other national programs that require national investments in primary health care.



Question 6 was added by CDC during negotiation of the study contract with IOM.


The study was conducted as part of the CDC core functions initiative, and involved a detailed set of survey questions and site visits to the states.


This estimate consists of $467 million for VFC and $140 million in vaccine purchase awards for the states in FY 1999; $474 million for VFC and $159 million in vaccine purchase awards for the states is estimated for FY 2000 (information provided by CDC).


In February 2000, for example, ACIP recommended that a newly licensed pneumococcal conjugate vaccine be added to the early childhood schedule. The vaccine is recommended for all infants up to age 2 and all high-risk children up to age 5 (CDC, 2000d). The pneumococcal vaccine (estimated to cost $232 for a four-dose series) will add an extraordinary incremental cost to state vaccine budgets, for which resources were not allocated in either the FY 2000 or FY 2001 federal Section 317 budget (Stolberg, 2000).


In April 2000, Senator Durbin (D-IL) and Senator Reed (D-RI) introduced a bill to require comprehensive health insurance coverage for childhood immunization (S. 2444).


ACIP approval of the pneumococcal conjugate vaccine occurred after the committee had formulated its vaccine purchase recommendations and is not reflected in this calculation.

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