to disadvantaged populations, 216

to final 10 percent of population, 47–50

full immunization, 94

local determinants of, 50

Medicaid coverage, 64, 78

Medicare reimbursement, 24, 86–87

obstacles to monitoring, 24–25, 122, 148

reimbursement issues, 63

VFC spending, 78

Cost of vaccines

client out-of-pocket costs as barrier to immunization, 129– 130

determinants of, 100 n.1

full immunization, 21, 57, 94

influenza, 21, 89, 205

Medicaid coverage, 78

pneumococcal, 21, 89, 205, 227 n.4

public-sector discount, 21

trends, 57, 92

Council of State and Territorial Epidemiologists, 107

Coverage levels 1996 goals, 165

access to services as factor in, 133

accomplishments of national immunization program, 66

accountability issues, 150, 151

adult immunization, 4, 29, 69, 87, 217–220

among immigrant populations, 59–60

CDC pockets-of-need strategy, 178–180

challenges to improving, 4, 32, 146–148

client awareness intervention to improve, 136–138

cost determinants, 50

cost of achieving current levels, 19–29

current child levels, 19

current inadequacy, 3–4, 67–70

data sources, 110

disparities in adult vaccination, 69–70, 87, 218

disparities in childhood vaccination, 4, 29–31, 67–69

expanding access to services to improve, 129–133

extent of insurance coverage and, 74, 76–77, 144–146

focus on 2-year-olds, 19–21

goals, 1, 4

impact of budget reductions, 185

improving, 47

measurement methodologies, 110–115

in metropolitan areas, 4, 29–31

needs and performance measures, 17, 123, 146, 210, 226–227

NVAC recommendations to improve, 145

perceived acceptable levels, 108– 109

potential scope of federal programs, 81–83

private-sector immunization delivery and, 9, 151

as private-sector performance measure, 146

provider-based interventions to improve, 133–136

reducing client costs to improve, 129–130

risk of outbreaks, 3, 34–36

role of national immunization system, 6, 43–46, 47

role of registries in documenting, 116–117

role of registries in improving, 117

strategies to improve, 47, 128–129, 138–139, 151, 154

system-level interventions to improve, 139–140

variation by state, 60, 67



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement