Overcoming Barriers to Immunization A Workshop Summary (1994) / Chapter Skim
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2 IMMUNIZATION AND THE HEALTH CARE SYSTEM
2 IMMUNIZATION AND THE HEALTH CARE SYSTEM
Pages 14-23
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vaccine, three doses of oral polio vaccine, and one dose of measles-mumps-rubella vaccine. If the fourth dose of DIP vaccine is excluded, state immunization rates range from 56 to 81 percent.
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For immunization and other services, providers in the public and private sectors deliver varying sets of services, under diverse systems of compensation, to which families have differing degrees of access. For immunization in particular, no consensus seems to exist as to how responsibility for ensuring that children receive the appropriate care should be shared among parents, providers, payers, and health departments.
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Such shortages may leave children with acute care services but few preventive care services, including immunizations. Workshop participants also expressed concern that the quality of care available in many inner cities is poor.
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Thomas Vernon, with the Merck Vaccine Division, described a program operating in four states that reduces this problem: providers receive vaccine for Medicaid patients from Merck at no cost; as the vaccine is administered to children, Medicaid reimbursements for the cost of the vaccine are paid directly to Merck. The new federal vaccine purchase program will reduce the financial burden on providers (see below)
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Reliable predictors of underimmunization have proved elusive, however. For example, Tracy Lieu, from the Northern California Kaiser Permanente HMO, reported that without its separate immunization tracking system, Kaiser was unable to predict delayed immunization from information routinely available in their HMO database (Lieu et al., 1993~.
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The National Immunization Program at CDC directs many other federal immunization activities. Among its responsibilities are managing federal funds for vaccine purchase, administering grants to states (including those for Immunization Action Plans)
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State responsibilities and participation in immunization-related activities vary. Common roles include establishing immunization requirements for daycare and school entry, setting Medicaid reimbursement levels, and distributing publicly purchased vaccines.
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From page 23... ...
Public health departments will remain responsible for developing policy, assessing the need for individual and community health services, and assuring that those services are provided (IOM, 19881. With better information about a community's needs, health departments also are likely to assume an enhanced role in outreach and education.
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