Incentivising appropriate care: the case of immunizations.

Incentivising appropriate care is a two-way street. Patients need to take greater responsibility and provider payment systems need to reward the best quality care. Today we are seeing the reemergence of many vaccine-preventable diseases that we thought were eradicated long ago for all practical purposes. In the U.S., diphtheria, polio, measles, mumps, and rubella all are on an upsurge. In this era of stringent cost containment and "managed care," preventive childhood immunizations offer one of the highest financial returns on investment we can achieve. So why have our inner cities become worse than some third-world countries in terms of low immunization rates for preschool age children and high infant mortality? We argue that "it's the money."