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Calling the Shots: Immunization Finance Policies and Practices
The committee was tasked to conduct an 18-month study that involved both extensive data collection and careful deliberations about the nature, scope, impact, and cost of the national immunization partnership for both children and adults. The committee met five times to consider relevant research data and expert testimony (see Appendix C for a list of sources that contributed to the committee’s deliberations). The committee heard testimony from congressional staff; officials of federal, state, and local health agencies; and organizations representing public and private health care professionals.
In May 1999, the committee released an interim report that addressed two key concerns posed by CDC: (1) the experience with carryover (unobligated funds) in the administration of the Section 317 program, and (2) the impact of SCHIP on the need for federal Section 317 funds for both infrastructure initiatives and vaccine purchase (IOM, 1999a).
Recognizing that local circumstances and economic and social factors strongly influence the levels of need and the quality and scope of immunization services within the states, the committee organized two major fact-finding efforts to illustrate and compare the ways in which states allocate resources for health care services and infrastructure. These efforts included (1) a national survey of 50 states and the District of Columbia conducted by a research team at the University of Michigan,13 and (2) a set of eight case studies (Alabama, Maine, Michigan, New Jersey, North Carolina, Texas, Washington State, and a two-county comparison of San Diego and Los Angeles counties in California), prepared by a team of project consultants.14 Four site visits were organized to supplement the national survey and case study materials.15 State-level data were also drawn from background materials and data analyses provided by CDC’s National Immunization Program, including proposals submitted by case study states for Section 317 funds in FY 1992, 1995, 1999, and 2000.16 In addition, the committee sponsored a workshop on pockets-of-need issues, held in September 1999.
Committee members and staff met frequently with state health officials over the course of the study17 and received materials pertaining to state and private immunization efforts from the American Academy of Pediatrics, the American Association of Health Plans, the Association of Maternal and Child Health Programs, the Association of State and Territorial Health Officers, the Health Insurance Association of America, the National Association of City and County Health Officers, and the National Association of WIC Directors. Additional materials regarding state roles in public health were provided by the National Governors’ Association and the National Conference of State Legislatures. Information on public-and private-sector investments in immunization services was also obtained through literature searches.