For the Public's Health Investing in a Healthier Future (2012) / Chapter Skim
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3 Informing Investment in Health
3 Informing Investment in Health
Pages 75-100
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From page 75... ...
And improved information will allow leaders of public health agencies to make better management decisions about organizing, staffing, and implementing public health activities that maximize the efficiency, reach, and effects of their operations. Research is also needed to generate objective information about the costs and outcomes of public health activities -- information that would facilitate assessments of the comparative effectiveness of public health and social interventions and medical approaches, and allow decision makers in government and the private sector to identify better ways of allocating limited resources across the spectrum of health-related investment (Teutsch and Fielding, 2011b)
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From page 76... ...
Because of a lack of adequate financial information, effective and efficient public health departments go unrewarded, and inefficient agencies face few incentives to improve (Honoré and Costich, 2009; Honoré et al., 2007)
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From page 77... ...
. The value of the data on state and local governmental public health revenues is greatly limited by the lack of a uniform chart of accounts used among health departments, which makes it impossible for health department personnel around the United States to report data on expenditures consistently (Gans et al., 2007)
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From page 78... ...
Accountability would be facilitated through uniform reporting of revenue and expenditures, and ultimately through establishing how financial inputs and outputs are associated with long-term outcomes. The financial accounting systems used by public health agencies are highly idiosyncratic, varying from one jurisdiction to another, and they are generally fashioned on a local or state government's template rather than being customized to meet the needs of public health departments.2 They are designed for budget management and fund accounting rather than for overall financial and program management, that is, understanding the linkages between resources, processes, outputs, and outcomes (see Figure 3-1, a logic model first introduced in the committee's report For the Public's Health: The Role of Measurement in Action and Accountability and outlining the steps to population health improvement from inputs to outcomes3)
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From page 79... ...
It would help local health departments to make more informed decisions on allocating their resources. The minimum package of public health services introduced in Chapter 2 to ensure a standard level of capacity in all jurisdictions could also serve as a framework for developing a chart of accounts, that is, preparing sets of accounts for each domain of foundational capabilities and each basic program.
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From page 80... ...
. Over the last several years, NACCHO and the University of Southern Mississippi have partnered to develop a Web-based Public Health Uniform Data System for local health departments (a project funded by the Robert Wood Johnson Foundation)
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From page 81... ...
It will be the closest thing yet to a uniform chart of public health accounts.5 The committee views the HHS and NACCHO effort as a step in the right direction. However, the committee notes that the type of classification described in the draft template appears to be based on the array of expense categories that are typically seen in health departments and does not appear to create mutually exclusive expense accounts as typical charts of accounts do.
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From page 82... ...
requirement in addition to being made a prerequisite for federal and state funding. The process of developing a chart of accounts needs to take place with consideration of the broader management needs of public health departments and the more difficult work of measuring and accounting for nonclinical services.
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From page 83... ...
83 INFORMING INVESTMENT IN HEALTH TABLE 3-1 Excerpt of a Hypothetical, Highly Simplified Public Health Chart of Accounts Account Category Account (Programs) Code Account Title Definition/Linked to Immunization All funds spent on immunizations 3000 Routine vaccine clinic administration 3010 Routine vaccine supply management 3020 Emergency mass immunization Linked to preparedness clinic category 3030 Communication on immunization Environmental Health 6000 Healthy Homes and Lead Hazard Linked to prevention Prevention Program programs category 6000.1 Public service announcements 6000.2 Staff training 6010 Compliance and enforcement, Air 6010.1 Outreach and education 6010.2 Permits 6020 Compliance and enforcement, Water Chronic Disease 9000 Asthma Linked to environmental health Obesity Linked to chronic disease Prevention and category Control 9010.1 Data collection, obesity (all ages)
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From page 84... ...
. The committee outlines below the thin evidence base that supports many areas of public health practice, the funding imbalances and the siloed nature of health research and development, and some specific needs.
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From page 85... ...
The nation's local, state, and federal public health agencies -- with their peers and partners in the private and public sectors -- constitute a vast but diffuse delivery system charged, to greater or smaller degrees, with implementing public health and prevention strategies (Teutsch and Fielding, 2011a)
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From page 86... ...
The nation's health research enterprise is further segmented into silos that focus on specific disease processes and biomedical pathways, thereby reducing opportunities for research that examines cross-cutting social and environmental pathways and for research on prevention opportunities outside clinical care settings. One way to begin to break those silos would be to include population-based research in comparative effectiveness research (most of which is clinically oriented)
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From page 87... ...
The committee concurs with the view that PCORI's comparative effectiveness analyses ought to include population-based interventions. However, even if PCORI's mission9 is not interpreted more broadly, the public health research enterprise must be extended to support comparing the effectiveness of population-based interventions.
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From page 88... ...
Those deficits constrain the volume, quality, and pace of research that can be conducted to discover effective prevention strategies and delivery system approaches. Producing the evidence needed for informed public health decision making will require investment in targeted strategies to improve
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From page 89... ...
c. Encouraging early adoption of the system by key government and nongovernmental public health organizations and use of the system for performance reporting, quality improvement, planning, and policy development.
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From page 90... ...
Where evidence-based strategies are lacking, the development of new knowledge and efficacious public health strategies is imperative. It takes a strong research infrastructure to produce the evidence needed for optimizing the nation's portfolio of investment in public health and the nation's health expenditures on health in general, but, as noted by an earlier Institute of Medicine (IOM)
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From page 91... ...
• issemination and implementation research to determine the best D ways to organize, finance, and deliver effective prevention strategies to population groups that can benefit. • omparative effectiveness research and priority-setting studies to C determine which prevention strategies work best in which commu nity and institutional settings and in which population groups.
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From page 92... ...
. There are many gaps in public health knowledge about obesity.
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From page 93... ...
. Not enough is known about how health departments can become learning organizations and acquire an adaptive systems perspective that would enable them to function productively in the self-organizing partnerships that 10Much public health research is not practice-oriented, such as etiologic research, behavioral science, and laboratory science; but little research is aimed at closing the gap between research and practice, for example, research useful to those in the field who need to implement the best intervention for a given issue (Glasgow and Emmons, 2007)
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From page 94... ...
Yet, of every $100 in federal health research spending, less than $1 is devoted to research on how to deliver (and finance) interventions, and most of that small amount is spent on delivery system research focused on medical care and only a minuscule portion on public health systems and services research (Woolf, 2007, 2008)
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From page 95... ...
The field must find ways to reach more of the populations that are at great risk for preventable disease and injury and must seek out new and more effective prevention strategies. The committee believes that knowing what works in population health is critical for the future of our nation, and the rate of spending on research and development in public health needs to be similar to that in the industries mentioned above -- perhaps up to 15 percent of total public health expenditures.
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From page 96... ...
. Enhancing the research capacity of public health departments is consistent with the idea of public health departments as knowledge organizations described in Chapter 2.
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From page 97... ...
The recommended expert panels would anticipate future needs and capacities and adapt to changing circumstances. CONCLUDING OBSERVATIONS This chapter has described two kinds of efforts needed to revitalize the public health infrastructure by clarifying how public health funding is used: standardizing financial information, which will require the development and adoption of a uniform chart of accounts, and expanding public health research to improve public health effectiveness and make the best use of resources.
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From page 98... ...
2010. Viewing Public Health Financial Information from a Different Perspec tive: Financial Ratio Analysis in Florida County Health Departments.
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From page 99... ...
Prevent ing Chronic Disease Public Health Research, Practice and Policy 7(1)
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From page 100... ...
2011. 2010 National Profile of Local Health Departments.
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