Immunization

Pneumonia and influenza are the leading causes of vaccine- preventable death. The elderly suffer the most from these diseases and the costs to the federal government are substantial. Annual Medicare hospital reimbursement can be as high as $1 billion for the treatment of influenza alone. Reported use of pneumococcal and influenza vaccines among the elderly has more than doubled during the past decade, but immunization rates for both diseases remain low, and mortality is significant. Despite the low immunization rates, the Centers for Disease Control spends very little promoting pneumococcal and influenza vaccination. GAO believes that beefing up promotion efforts would boost immunization rates and save lives. GAO concludes that efforts to improve health care providers' compliance with adult immunization guidelines are more promising than are attempts to influence consumers' knowledge and attitudes. Doctors have a strong impact on patients' vaccination decisions, but they often fail to recommend vaccination for patients for whom it is indicated. Computer-based reminder systems, checklists appended to medical records, practice-based tracking systems, and the issuance of standing orders for vaccination help to remedy this problem. The broad-based implementation of a hospital policy to vaccinate eligible high-risk patients before discharge shows much promise to reduce vaccine-preventable mortality among adults.

GAO found that: (1) although the use of pneumococcal and flu vaccines among the elderly has more than doubled in the past 10 years, immunization for both diseases remains low; (2) in the 14 years since Medicare authorized coverage for pneumococcal vaccination, HHS has done little to enhance its use aside from providing Medicare payment; (3) although antibiotic resistance to pneumococcal bacteria is increasing, it is unlikely that HHS will reach its vaccination goal of 60 percent by 2000; (4) although HHS has made major efforts to enhance the use of the flu vaccine, HHS is discouraged from spending more of its immunization funding on the elderly; (5) HHS may reach its 60-percent flu immunization goal by 2000, since vaccination rates have steadily increased since 1989 and HHS plans to enhance its promotional strategies; (6) although the Centers for Disease Control has typically spent very little on adult immunization services, it is important to increase spending to raise immunization rates and save lives; (7) efforts to improve health care providers' compliance with adult immunization guidelines are promising; and (8) the implementation of a hospital policy to vaccinate eligible high-risk patients before discharge may reduce vaccine-preventable mortality among adults.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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