Institute of Medicine Committee on Immunization Finance Dissemination Workshop

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Institute of MedicineCommittee on Immunization
Finance Dissemination Workshop

• Financing the U.S. Immunization System
• The Need for a Strategic Vision
• June 15, 2001
• Chicago, Illinois
• A Tale of Two Cities The Status of Immunization
  Infrastructure in Detroit

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Detroit Health Department

• James A. Buford, M.P.H
• Public Health Director
• Judith Harper West, M.P.H
• Deputy Public Health Director

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• My role (in the workshop)
• Focus on local (Detroit) concerns in financing
  immunization programs in Michigan
• Reflect on the findings and recommendations of
  the IOM report
• Discuss experience in obtaining support for
  immunization infrastructure efforts within the
  city of Detroit
• Identify unmet challenges that require attention
  by state and local agencies and private health
  plans

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Detroit demographics

• Population (2000 Census) 951,270
• 1998/1999 birth numbers 16,429/15,800
• Poverty level 29 of all families, and 57 of
  female-headed families with child(ren) live at
  poverty level
• Uninsured estimated 137,000 (14) are
  without health insurance an additional 109,000
  (11) have some gaps in their insurance

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• Opening line of Dickens A Tale of Two Cities
• It was the best of times, it was the worst of
  times, it was the age of wisdom, it was the age
  of foolishness, it was the epoch of belief, it
  was the epoch of incredulity, it was the season
  of Light, it was the season of Darkness, it was
  the spring of hope, it was the winter of despair,
  we had everything before us, we had nothing
  before us, we were all going direct to heaven, we
  were all going direct the other way

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Detroits Wake-up Call

• 1992
• 29

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• Detroit Immunization Levels National
  Immunization Survey

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Resources obtained were primarily directed
towards the following areas

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•          WIC/Immunization connection
  implementation
•         Immunization outreach and promotion into
  the community, especially coalition building
•          Timely data entry and information
  (registry) system upgrades that would assist in
  population-wide surveillance of immunization
  coverage levels
•          Increasing access to immunization
  delivery

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Infrastructure

• Defined as
• an underlying base or foundation
• Refers to
• the basic facilities, equipment, and
  installation needed for the functioning of a
  system

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Focus, in our planning and development

• Core public health functions
• assessment,
• policy development
• assurance

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Public Health Accreditation

• Challenge
• Opportunity

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Unmet challenges

• Widespread, concerted focus on the delivery of
  healthcare through managed care organizations and
  the establishment of a medical home continues to
  foster gaps in both immunization delivery and
  access to walk-in services

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Unmet challenges (cont.)

• WIC/Immunization connection (enhanced
  immunization assessments in WIC and/or
  WIC-associated immunization services)

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Unmet challenges (cont.)

• Immunization registries as a tool to accurately
  assess and improve immunization levels

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Unmet challenges (cont.)

• Immunization awareness and recognition of need
  additional awareness that benefit of immunization
  outweighs the risk

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Role of the National Immunization System

• Assure Vaccine Purchase
• Assure Service Delivery
• Control and Prevent Infectious Diseases
• Conduct Surveillance of Vaccine Coverage and
  Safety
• Sustain and Improve Coverage Levels
• Immunization Finance Policies and Practices

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Funding stability consistent and comparable
monitoring measures

• A successful strategy
• Accomplishing national goals

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• In the words of Sydney Carton at the very end of
  A Tale of Two Cities,
• "It is a far, far better thing that I do, than I
  have ever done."

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• ...it is a far, far better rest that I go to
  than I have ever known."