A Uniform Chart of Accounts for Public Health Agencies: An “Essential Ingredient” for a Strong Public Health System

Bekemeier, Betty; Singh, Sukhpal; Schoemann, Alexander W.

doi:10.1097/phh.0000000000000793

Cited by 16 publications

(22 citation statements)

References 7 publications

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“…The PHAST team had experience with using and obtaining public health agency financial data for prior studies demonstrating the impact of public health investments on population health outcomes and in identifying gaps in FPHS spending 13–15. During 2016-2017, and in collaboration with state and local public health leaders across the country, the UCOA was developed, with funding from the Robert Wood Johnson Foundation (RWJF), to allow state and local agencies to report spending on activities and related funding sources along a set of practice-defined program areas and capabilities 5…”

Section: Programmentioning

confidence: 99%

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A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data

Bekemeier

Heitkemper²,

Zaichkin³

et al. 2022

Journal of Public Health Management and Practice

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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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Section: Programmentioning

confidence: 99%

“…The UCOA reporting tool established by PHAST collects and reports detailed financial data from public health agencies, using a crosswalk approach 5. Building on the FPHS framework, the UCOA captures expenditure and revenue data for 6 crosscutting capabilities and 7 major program areas, further broken down into 44 subcategories (Table 1).…”

Section: Programmentioning

confidence: 99%

A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data

Bekemeier

Heitkemper²,

Zaichkin³

et al. 2022

Journal of Public Health Management and Practice

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“…also found a positive association between PH expenditures on programs that relate to PH agencies' capabilities and agency performance The framework for these previously reported studies from the early 2000's was based on performance information collected through survey-driven, self-reported evaluation that focused on individual LHDs. A number of these studies noted the need for a standardized national performance assessment instrument ( 22 , 24 , 27 , 28 ), as variations in LHDs' data structure and reporting processes often hinder comparative assessment of agency performance ( 16 , 28 – 30 ).…”

Section: Introductionmentioning

confidence: 99%

“…Accreditation recognizes health departments that meet standards designed to assess agencies' readiness to respond to PH needs and facilitates continuous quality improvement and performance ( 36 ). PHAB accreditation serves as a national performance assessment for PH that had been noted as a need in previous studies ( 22 , 24 , 27 , 28 ).…”

Section: Introductionmentioning

confidence: 99%

Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores

Dada

Bekemeier

Flaxman

et al. 2022

Front. Public Health

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ContextFoundational 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.ObjectivesWe examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards.MethodsWe used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards.ResultsAnalyses 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.ConclusionsInvestment 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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“…The effort required and the difficulties of matching existing and nonstandardized data limit what can be examined regarding the impact of public health investments on population health. Thus, widely accepted and standardized data are needed to promote research 16,[53][54][55].…”

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confidence: 99%

Analytic approaches to assess the impact of local spending on sexually transmitted diseases

Grembowski

Lim

Pantazis³

et al. 2022

Health Services Research

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Objective To compare the estimated associations between annual sexually transmitted diseases (STD) expenditures per capita and STD incidence rates among Florida and Washington local health departments (LHDs) from 2001 to 2017, using two approaches—a longitudinal regression model with lagged STD spending and a regression model with the Arellano–Bond panel estimator. Data sources Secondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government. Study design We examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017, with LHDs as the unit of analysis. We compared two regression models: generalized estimating equations (GEE) and the Arellano–Bond panel estimator (an instrumental variable approach). Data collection The secondary data were combined to build a longitudinal panel database for LHDs in Florida and Washington from 2001 to 2017. Principal findings In the GEE model with both states, greater STD spending in a prior year was associated unexpectedly with greater STD incidence rates in succeeding years. The Arellano–Bond models for both states had the expected inverse associations but were not significant. In the Arellano–Bond models for Florida, a $1 increase in STD spending in previous years was followed by decreases in STD incidence rates ranging between 29 and 58 points in succeeding years (0.09 ≥ p ≥ 0.04). Conclusions In longitudinal panel data for LHDs in two states, the Arellano–Bond estimator, or other instrumental variable approach, is preferred over conventional regression models to obtain unbiased estimates of the relationship between annual STD spending rates and annual STD rates. Future studies will require accurate, standardized, and detailed longitudinal data and rigorous analytic approaches, such as those illustrated in our study.

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A Uniform Chart of Accounts for Public Health Agencies: An “Essential Ingredient” for a Strong Public Health System

Cited by 16 publications

References 7 publications

A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data

A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data

Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores

Analytic approaches to assess the impact of local spending on sexually transmitted diseases

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