Transcript Advancing a Field of Study in Public Health Finance

Advancing a Field of Study in
Public Health Finance
Emory University
Rollins School of Public Health
September 23, 2005
Peggy A. Honoré, DHA, MHA
Chief Science Officer
Mississippi Department of Health
[email protected]
Funded through an award from the RWJ Foundation
Public Health Finance
Advancing as a field of study because
of the Sense of Urgency to understand the
composition, utilization, and impacts of the
finances that fund all components of the
public health system
Jones & Honoré, 2005
Justifications
“Efforts at systematic nationwide studies of financing for public
health have failed because of their exclusive focus on the budgets
of state and local public health agencies rather than the funding
of the public health system”
“Almost no data are available on how much would be needed to
adequately build and sustain the necessary public health
infrastructure”
“…Lack of systems of accountability to ensure quality and
availability of public health services”
The Future of Public Health in the 21st Century, 2003
Public Health Systems Research
A field of inquiry examining the organization,
financing, and delivery of public health
services at local, state and national levels,
and the impact of these activities on
population health………
Mays, Halverson, Scutchfield, JPHMP2003
Public Health Finance
as a component of
Public Health Systems Research
Focus of this RWJ funded project:
PUBLIC HEALTH FINANCE:
Advancing a field of study through
Public Health Systems Research
http://www.sph.emory.edu/PHSR
Defining Public Health Finance
Public Health Finance is a field of science
and practice that deals with the acquisition,
management, and use of financial resources
to advance the health of populations through
prevention and health promotion
Moulton, Halverson, Honoré, Berkowitz, JPHMP2004
Questions/Debate persist regarding
the Definition
Healthcare Finance
Louis C. Gapenski, 2004
• The definition depends on the context
– Policy maker or manager
– Type of healthcare organization
• Practice setting………..
Healthcare Finance is the practice of
finance, including both accounting
and financial management within
health services organizations
Healthcare Finance
Competencies
Grounded in financial theory
and
industry financial management practices
Mauer & Grazier, Task force Report on Development of Core Competencies in Health Care Finance
Steps to advancing a similar
theoretical and empirical base in
Public Health Finance
through the RWJ funded project
Public Health Finance
Theoretical and Empirical Base
Thomas E. Getzen, PhD
Rest on three conceptual pillars:
I. The theory of investment (Finance)
II. The theory of public goods (Economics)
III. The theory of population health action (Public Health)
Theory of Investment
(Finance)
Thomas E. Getzen, PhD
Essential Elements
Risk and Timing
• What risks exceed market capacity and require government
action? (hurricanes, epidemics, war)
• What risks perceptions are difficult and require information
from regulatory agencies? (SEC, FDA)
• Which investments provide such diffuse benefits that they
cannot be financed through individual or corporate actions?
(NIH, CDC, NCHS)
Theory of Public Goods
(Economics)
Thomas E. Getzen, PhD
• Public goods answers the question of why
people must engage in collective action in
order to reap the benefits of individual
exchange in the marketplace
• Well established work on the allocation of
funding and financial rewards from research
has not yet been widely translated and applied
to the field of public health
Theories of democracy demonstrate
that the public’s health is an important
collective [public] good because funds
are expended to benefit all or
most of the population
Walzer, 1983
The Theory of Population Health Action
(Public Health)
Thomas E. Getzen, PhD
• Salient linkages to finance and economics
include:
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the assessment of risk
the evaluation of distributional consequences
the incidence of fee-based and tax financing
vaccine pricing
funding prevention and health promotion
and many others…….
Competencies
What should public health mangers
know about finance?
• Very little content is offered in the accredited SPHs that directly
address public health finance concepts
• Only 8 of 32 programs surveyed offered a course with some
content relevant to public health finance
• Public Health respondents to a survey added competencies that
should be taught such as knowledge about the appropriations
process, public financing, governmental systems
• Finance typically a sub-set under a broader category
(e.g. management) in national public health competency reports
Gillespie,Kurz, McBride,Schmitz, JPHMP 2004
What do we know about the
finances that fund the public
health system?
National Health Expenditures
2003
• $1,678.9 = Total NHE
• $53.8 = Governmental Public Health Activities
(3.2% of Total)
CMS National Health Expenditures-Table 3, 2003
Local Health Agency
All LPHAs
Metropolitan
Average
Annual
Expenditures
$4,505,096
Median
$8,930,091
$1,185,433
$1,195,632
$509,540
$437,637
$66,200,000
$214,658
$27,000,000
$621,100
Non-Metropolitan
0 to 24,999
Population
500,000 or more
NACCHO LPHA INFRASTRUCTURE: A CHARTBOOK 2001
* 1999
Local Health Agency
Budget by Funding Source *
• 44% - Local
• 30% - State
• 19% - Service reimbursement
• 3% - Federal
• 4% - Other
NACCHO LPHA INFRASTRUCTUREA CHARTBOOK 2001
* 1999
State Expenditures – FY 2003
Total Population Health Expenditures
– $19.2 B
– 5.4% of State Health Expenditures
• Prevention of Epidemics/Disease
– $1.9 B
• Protect Against Environmental Hazards
– $5.6 B
• Injury Prevention
– $1 B
• Promotion of Chronic Disease/healthy Behavior
– $5.9 B
• Disaster Preparedness/Response
– $2.3 B
• Health Infrastructure
– $2.5 B
2002-2003 State Health Expenditure Report, NASBO/Milbank 2005
CDC Per Capita Dollars to States
2004
$14.93 - National Average
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Top 5
$45.74 - Alaska
$32.39 - Vermont
$28.63 Wyoming
26.50 - North Dakota
$26.31 - Rhode Island
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Bottom 5
$ 9.61 - Indiana
$ 9.69 - Ohio
$10.53 - Pennsylvania
$11.12 - Florida
$11.42 - Virginia
Shortchanging America’s Health:
A State-By-State look at How Federal Public Health Dollars are Spent
Trust for America’s Health, 2005
Financial Related Research Findings
• Higher LHA performance capacity was greater based on
agency expenditures per capita…Kennedy, JPHMP, 2003
• Effective health departments have larger annual
expenditures and derive their budgets from a larger number
of funding sources while ineffective agencies tend to have
Medicaid as a significant source of their budget...Handler &
Turnock, JPHP, 1996
• Higher performing public health jurisdictions had higher
taxes per capita….Honoré, Simoes, Jones, Moonsinghe, JPHMP, 2004
• Agency spending is a significant predictor of
performance…Mays et al, JPHMP, 2004
Topics of Interest
• Impact of public health funding on health
outcomes
• Taxonomies for systematically measuring and
analyzing the national investment in the public
health system
• Costs of optimal agency and system performance
• Comparisons of flexible and categorical funding
sources
• Analysis of funding gaps in the public health
system
Data
Hot Topics in
Public Health Systems Research
Where’s the Data?
AcademyHealth 2005
Public Health Systems Research Interest Group Meeting
Data Collection
• 1970 - ASTHO/PHF Data Reporting System
established
• 1995 - Federal funding for the system eliminated
• 1997 - NACCHO LPHA Infrastructure CHARTBOOK
• 2005- NASBO/Milbank State Health Care Expenditure
Report
• 2005 - HP2010 Objective (23-16) for $ data deleted
Lack of financial data limits the ability to
conduct system-wide public health research
and analysis…
We know little about where the [health]
dollars are spent and what they are purchasing
Thorpe,HCFR 1999
Recommended Strategies for Obtaining
Public Health Infrastructure Data
Lewin Group, 1997
• Data reporting by state and local public
health agencies should be linked to funding
streams
• The feasibility of using the ten essential
services as a data collection tool should be
carefully [cautiously] considered
– not currently structured, organized, or funded in a similar manner
Advancing Forward
Funded by: Robert Wood Johnson Foundation
• Conference - Feb 8, 2006 - APHA Headquarters D C
• Emory Meetings • Speaker’s Bureau • Website (www.sph.emory.edu/PHSR)
System-wide representation:
APHA, Pfizer, NGA, NCSL, NACCHO, ASTHO, NALBOH,
US Senate, DHHS, CDC, Institute of Medicine, Turning Point,
AcademyHealth, MS Department of Health, GA Division of
Public Health, Metro Nashville Department of Health, The
California Endowment, National Health Policy Forum,
Emory University, East Carolina University, Medical
University of South Carolina, University of Arkansas for
Medical Sciences, Temple University, University of
Pittsburgh, Johns Hopkins University, University of North
Carolina Chapel Hill
Journal of Public Health Management and Practice
September/October 2004
Issue Focus:
Public Health Finance
http://www.jphmp.com
Journal of Public Health Management and Practice
2nd Public Health Finance Issue
January/February 2007
• Analysis of the variation in public health funding
• Next steps to advancing public health finance and a national
investment plan
• Documentation of public health funding formulas and strategies
• Methodologies for local health agency financial analysis
• State Health Department Data Collection Case Study
• Examination of increased county revenues on local public health
funding and community health status
• Newborn screening program financing issues
• Examination of different funding mechanisms to improve the
prevalence of dental sealants among Medicaid eligible children
• Case study of changes in methods for classifying public health
state appropriations
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