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McCullough JM, Ghimire U, Orr JM, Onal SO, Edmiston A, Patel K, McCall TC, Leider JP. Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System. Health Aff (Millwood) 2024; 43:846-855. [PMID: 38830150 DOI: 10.1377/hlthaff.2024.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.
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Affiliation(s)
| | - Umesh Ghimire
- Umesh Ghimire, Indiana University, Indianapolis, Indiana
| | - Jason M Orr
- Jason M. Orr, University of Minnesota, Minneapolis, Minnesota
| | | | - Ashley Edmiston
- Ashley Edmiston, National Association of County and City Health Officials, Washington, D.C
| | - Krishna Patel
- Krishna Patel, National Association of County and City Health Officials
| | - Timothy C McCall
- Timothy C. McCall, National Association of County and City Health Officials; and George Washington University, Washington, D.C
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2
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Liang R, Kiang MV, Grant P, Jackson C, Rehkopf DH. Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality. Prev Med Rep 2023; 36:102410. [PMID: 37732021 PMCID: PMC10507150 DOI: 10.1016/j.pmedr.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic has revealed consequences of past defunding of the U.S. public health system, but the extent to which public health infrastructure is associated with COVID-19 burden is unknown. We aimed to determine whether previous county-level public health expenditures and community health planning activities are associated with COVID-19 cases and deaths. We examined 3050 of 3143 U.S. counties and county equivalents from March 1, 2020 to February 28, 2022. Multivariable-adjusted linear regression and generalized additive models were used to estimate associations between county-level public health expenditures and completion of community health planning activities by a county health department with outcomes of county-level COVID-19 cases and deaths per 100,000 population. After adjusting for county-level covariates, counties in the highest tertile of public health expenditures per capita had on average 542 fewer COVID-19 cases per 100,000 population (95% CI, -1004 to -81) and 21 fewer deaths per 100,000 population (95% CI, -32 to -10) than counties in the lowest tertile. For analyses of community health planning activities, adjusted estimates of association remained negative for COVID-19 deaths, but confidence intervals included negative and positive values. In conclusion, higher levels of local public health expenditures and community health planning activities were associated with fewer county-level COVID-19 deaths, and to a lesser extent, cases. Future public health funding should be aligned with evidence for the value of county health departments programs and explore further which types of spending are most cost effective.
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Affiliation(s)
- Richard Liang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Mathew V. Kiang
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Philip Grant
- Stanford University School of Medicine, Department of Medicine – Infectious Diseases, 300 Pasteur Drive, Lane Building 134, Stanford, CA 94305, United States
| | - Christian Jackson
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
| | - David H. Rehkopf
- Stanford University School of Medicine, Department of Epidemiology and Population Health, Alway Building, 300 Pasteur Drive, Stanford, CA 94305, United States
- Stanford University School of Medicine, Division of Primary Care and Population Health, 1265 Welch Road, Stanford, CA 94305, United States
- Stanford University, Department of Sociology, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA 94305, United States
- Stanford University, Center for Population Health Sciences, 1701 Page Mill Road, Palo Alto, CA 94304, United States
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Bekemeier B, Heitkemper E, Zaichkin DL, Whitman G, Singh SR, Leider JP. A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E69-E78. [PMID: 36477581 DOI: 10.1097/phh.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT The COVID-19 pandemic made the long-standing need for a national uniform financial reporting standard for governmental public health agencies clear, as little information was available to quantify state and local public health agencies' financial needs during the pandemic response. Such a uniform system would also inform resource allocation to underresourced communities and for specific services, while filling other gaps in practice, research, and policy making. This article describes lessons learned and recommendations for ensuring broad adoption of a national Uniform Chart of Accounts (UCOA) for public health departments. PROGRAM Leveraging previous efforts, the UCOA for public health systems was developed through collaboration with public health leaders. The UCOA allows state and local public health agencies to report spending on activities and funding sources, along with practice-defined program areas and capabilities. IMPLEMENTATION To date, 78 jurisdictions have utilized the UCOA to crosswalk financial information at the program level, enabling comparisons with peers. EVALUATION Jurisdictions participating in the UCOA report perceptions of substantial up-front time investment to crosswalk their charts of accounts to the UCOA standard but derive a sense of valuable potential for benchmarking against peers, ability to engage in resource allocation, use of data for accountability, and general net positive value of engagement with the UCOA. IMPLICATIONS FOR POLICY AND PRACTICE The UCOA is considered a need among practice partners. Implementing the UCOA at scale will require government involvement, a reporting requirement and/or incentives, technical assistance, financial support for agencies to participate, and a means of visualizing the data.
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Affiliation(s)
- Betty Bekemeier
- University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier and Mr Whitman); School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Heitkemper); Pacific Lutheran University School of Nursing, Tacoma, Washington (Dr Zaichkin); School of Public Health, University of Michigan, Ann Arbor, Michigan (Dr Singh); and School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider)
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Orr JM, Leider JP, Kuehnert P, Bekemeier B. COVID-19 Revealed Shortcomings Of The US Public Health System And The Need To Strengthen Funding And Accountability. Health Aff (Millwood) 2023; 42:374-382. [PMID: 36877906 DOI: 10.1377/hlthaff.2022.01234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The US governmental public health system, which includes federal, state, and local agencies, is seen by many observers as having a money problem, stemming from a lack of resources. During the COVID-19 pandemic, this lack of resources has had unfortunate consequences for the communities that public health practice leaders are expected to protect. Yet the money problem is complex and involves understanding the nature of chronic public health underinvestment, identifying what money is spent in public health and what the country gets for it, and determining how much money is needed to do the work of public health in the future. This Commentary elucidates each of these issues and provides recommendations for making public health services more financially sustainable and accountable. Well-functioning public health systems require adequate funding, but a modernized public health financial data system is also key to the systems' success. There is a great need for standardization and accountability in public health finance, along with incentives and the generation of research evidence demonstrating the value of and most effective delivery for a baseline of public health services that every community should expect.
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Affiliation(s)
- Jason M Orr
- Jason M. Orr, University of Minnesota, Minneapolis, Minnesota
| | | | - Paul Kuehnert
- Paul Kuehnert, Public Health Accreditation Board, Alexandria, Virginia
| | - Betty Bekemeier
- Betty Bekemeier , University of Washington, Seattle, Washington
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Dada OO, Bekemeier B, Flaxman A, de Castro AB. Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores. Front Public Health 2022; 10:861587. [PMID: 35692346 PMCID: PMC9174657 DOI: 10.3389/fpubh.2022.861587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023] Open
Abstract
Context Foundational Capabilities (FC) are the public health (PH) infrastructure areas that are essential for local health departments (LHDs) to support a "minimum package" of programs and services that promote population health. Despite being a critical component of LHD programs, FC are chronically underfunded, and studies specific to the relationship between LHD FC expenditures and their performance-the LHDs' ability to provide essential PH programs and services to their community-have not been previously reported. Public Health Accreditation Board (PHAB) accreditation is a nationally recognized accreditation program for PH agencies. PHAB accreditation assesses LHDs' performance against sets of standards that are based on the 10 essential PH services. Alignment between FC and the PHAB standards presents a means for assessing LHD FC expenditures relative to their performance in PHAB accreditation standards. Objectives We examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards. Methods We used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards. Results Analyses showed that a dollar increase in total FC expenditures is associated with a 0.2% increase in the aggregate performance score in selected PHAB standards as well as the performance score on most of the standards examined. LHDs that allocated FC budgets more evenly across FC programs were found to be more likely to have higher scores. Conclusions Investment in FC could improve LHD performance scores in PHAB accreditation standards and support LHDs' capability for improving community health outcomes. Allocating available FC resources across the various FC programs could support better LHD performance, as indicated by accreditation scores. This study contributes to advancing the understanding of public health finances in relation to performance and could help guide effective LHD resource allocation.
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Affiliation(s)
- Oluwatosin O. Dada
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States,*Correspondence: Oluwatosin O. Dada
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Abraham Flaxman
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - A. B. de Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
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HOGG‐GRAHAM RACHEL, GRAVES ELIZABETH, MAYS GLENP. Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure. Milbank Q 2022; 100:261-283. [PMID: 35191076 PMCID: PMC8932630 DOI: 10.1111/1468-0009.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in delivery systems. The results of our study suggest that the public health system structure can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities can help communities efficiently use limited time and resources and identify the most effective pathways for building a stronger public health system and improving health outcomes over time. CONTEXT While the novel coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in public health delivery systems. Information about the relative value in the implementation of recommended population health capabilities can help communities prioritize their use of limited time and resources and identify the most effective pathways for building a stronger public health system. METHODS We used a longitudinal cohort design with data from the National Longitudinal Survey of Public Health Systems to examine longitudinal and geographic trends in the delivery of population health capabilities and their impact on system strength across communities in the United States. We used linear probability models to ascertain whether the delivery of certain capabilities added value to public health system strength. FINDINGS Those communities with the strongest classification of public health system structure in both urban and rural areas implemented the largest set of population health capabilities. Results from the linear probability model indicate that a set of population health capabilities are associated with increased public health system strength. Key activities include allocating resources based on a community health plan, surveying the community for behavioral risk factors, analyzing the data on preventive services use, and engaging community stakeholders in health improvement planning (p < 0.01). CONCLUSIONS The results of this study suggest that public health systems can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities may help communities increase their public health system's capacity and improve health outcomes.
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Affiliation(s)
| | | | - GLEN P. MAYS
- Colorado School of Public HealthAnschutz Medical Campus
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Yeager VA, Balio CP, McCullough JM, Leider JP, Orr J, Singh SR, Bekemeier B, Resnick B. Funding Public Health: Achievements and Challenges in Public Health Financing Since the Institute of Medicine's 2012 Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E244-E255. [PMID: 33605671 DOI: 10.1097/phh.0000000000001283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report "For the Public's Health: Investing in a Healthier Future." DESIGN Qualitative study involving key informant interviews. SETTING AND PARTICIPANTS Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report. MAIN OUTCOME MEASURES Qualitative feedback about changes to public health finance since the report. RESULTS Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow. CONCLUSIONS Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level. IMPLICATIONS FOR POLICY AND PRACTICE Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Balio); College of Health Solutions, Arizona State University Phoenix, Phoenix, Arizona (Dr McCullough); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Kansas Foundation for Medical Care, Topeka, Kansas (Mr Orr); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier); and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Resnick)
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8
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Orr JM, Leider JP, Singh S, Balio CP, Yeager VA, Bekemeier B, McCullough JM, Resnick B. Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E316-E323. [PMID: 32956294 DOI: 10.1097/phh.0000000000001209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure. OBJECTIVES This review examines the influence of the Finance report's 10 recommendations on public health policy and practice. DESIGN This review utilized peer-reviewed and gray literature published since 2012. ELIGIBILITY CRITERIA Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community. RESULTS Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts. DISCUSSION Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending. CONCLUSIONS The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.
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Affiliation(s)
- Jason M Orr
- Kansas Health Institute, Topeka, Kansas (Mr Orr); Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Ms Balio and Dr Yeager); Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier); School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona (Dr McCullough); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Resnick)
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Krasna H, Fried L. Generation Public Health: Fixing the Broken Bridge Between Public Health Education and the Governmental Workforce. Am J Public Health 2021; 111:1413-1417. [PMID: 34464186 PMCID: PMC8489610 DOI: 10.2105/ajph.2021.306317] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Heather Krasna
- Heather Krasna is with Columbia University Mailman School of Public Health, New York, NY, and the Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. Linda Fried is with Columbia University Mailman School of Public Health
| | - Linda Fried
- Heather Krasna is with Columbia University Mailman School of Public Health, New York, NY, and the Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. Linda Fried is with Columbia University Mailman School of Public Health
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10
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Singh SR, Leider JP, Orcena JE. The Cost of Providing the Foundational Public Health Services in Ohio. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:492-500. [PMID: 32956296 DOI: 10.1097/phh.0000000000001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre-COVID-19. DESIGN Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019. PARTICIPANTS Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans. RESULTS In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre-COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state. CONCLUSIONS A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.
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Affiliation(s)
- Simone R Singh
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); and Union County Health Department, Marysville, Ohio (Dr Orcena)
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11
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Krebs E, Nosyk B. Cost-Effectiveness Analysis in Implementation Science: a Research Agenda and Call for Wider Application. Curr HIV/AIDS Rep 2021; 18:176-185. [PMID: 33743138 PMCID: PMC7980756 DOI: 10.1007/s11904-021-00550-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review Cost-effectiveness analysis (CEA) can help identify the trade-offs decision makers face when confronted with alternative courses of action for the implementation of public health strategies. Application of CEA alongside implementation scientific studies remains limited. We aimed to identify areas for future development in order to enhance the uptake and impact of model-based CEA in implementation scientific research. Recent Findings Important questions remain about how to broadly implement evidence-based public health interventions in routine practice. Establishing population-level implementation strategy components and distinct implementation phases, including planning for implementation, the time required to scale-up programs, and sustainment efforts required to maintain them, can help determine the data needed to quantify each of these elements. Model-based CEA can use these data to determine the added value associated with each of these elements across systems, settings, population subgroups, and levels of implementation to provide tailored guidance for evidence-based public health action. There is a need to integrate implementation science explicitly into CEA to adequately capture diverse real-world delivery contexts and make detailed, informed recommendations on the aspects of the implementation process that provide good value. Summary We describe examples of how model-based CEA can integrate implementation scientific concepts and evidence to help tailor evaluations to local context. We also propose six distinct domains for methodological advancement in order to enhance the uptake and impact of model-based cost-effectiveness analysis in implementation scientific research.
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Affiliation(s)
- Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive V5A 1S6, Burnaby, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive V5A 1S6, Burnaby, British Columbia, Canada.
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12
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Maani N, Galea S. COVID-19 and Underinvestment in the Public Health Infrastructure of the United States. Milbank Q 2020; 98:250-259. [PMID: 32333418 DOI: 10.1111/1468-0009.12463] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nason Maani
- Boston University School of Public Health.,London School of Hygiene and Tropical Medicine
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13
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Local Health Departments' Spending on the Foundational Capabilities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:52-56. [DOI: 10.1097/phh.0000000000000922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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DeSalvo K, Parekh A, Hoagland GW, Dilley A, Kaiman S, Hines M, Levi J. Developing a Financing System to Support Public Health Infrastructure. Am J Public Health 2019; 109:1358-1361. [PMID: 31415208 PMCID: PMC6727291 DOI: 10.2105/ajph.2019.305214] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 11/04/2022]
Abstract
All people in the United States deserve the same level of public health protection, making it crucial that every health department across the country has a core set of foundational capabilities. Current research indicates an annual cost of $32 per person to support the foundational public health capabilities needed to promote and protect health for everyone across the nation. Yet national investment in public health capabilities is currently about $19 per person, leaving a $13-per-person gap in annual spending.To "create the conditions in which people can be as healthy as possible" and to protect national security, this gap must be filled. The Public Health Leadership Forum convened national experts in the public health, public policy, and other partner sectors to develop options for long-term, sustainable financing. The group aligned around core principles and criteria necessary to establish a sustainable financing structure.Informed by the work of the expert panel, the authors recommend a Public Health Infrastructure Fund for state, territorial, local, and tribal governmental public health, that would provide $4.5 billion of new, permanent resources needed to fully support core public health foundational capabilities.
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Affiliation(s)
- Karen DeSalvo
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Anand Parekh
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - G William Hoagland
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Abby Dilley
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sherry Kaiman
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Mason Hines
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Jeff Levi
- Karen DeSalvo is with the Dell Medical School, University of Texas at Austin. Anand Parekh and G. William Hoagland are with the Bipartisan Policy Center, Washington, DC. Abby Dilley, Sherry Kaiman, and Mason Hines are with RESOLVE, Washington, DC. Jeff Levi is with the Milken Institute School of Public Health, George Washington University, Washington, DC
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