• WIC clinics or coordinators,

• private-practice physicians, and

• managers and practitioners in federally qualified health care centers.

The information gathered during the site visits was incorporated into each state’s case study.

The case study reports were developed through interviews with state health department officials, including the immunization program directors, Medicaid agency staff, budget analysts, and CDC public health advisors to the state, among others. These interviews were, in most cases, coordinated with the initial telephone interview conducted by the research team for the state survey to minimize the imposition on the state respondent’s time and avoid duplication. In addition to the interviews with key program managers, the case study sites were asked to provide detailed information on state spending from all revenue sources for immunization activities for the period 1992 through 1998:

• federal grants,

• state revenues (in the case of Los Angeles and San Diego, county revenues as well), and

• foundation grants.

Reconstruction of this historical information, broken out by category of spending (e.g., personnel, contracts, aid to counties) was extraordinarily difficult and labor-intensive for the state health departments, involving the efforts of their own budget analysts and sometimes state budget office staff. The cooperation the committee received from all of the studied states in retrieving and reporting this information was extraordinary as well. The detailed reports of spending on immunization activities comprise an essential element of the information base used by the committee in developing its findings and recommendations.

Finally, the respective state grant applications to CDC for Section 317 funds for 1992, 1995, 1999, and 2000 were reviewed, providing another source of information over time for the case studies.