Local Fiscal Allocation for Public Health Departments

McCullough, J. Mac; Leider, Jonathon P.; Riley, William J.

doi:10.1016/j.amepre.2015.04.021

Cited by 12 publications

(11 citation statements)

References 28 publications

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“…[5][6][7] There is widespread acknowledgment that population health outcomes are determined by more than just governmental public health expenditures. 6,8,9 One recent study, addressing this topic at the state level, found that a higher ratio of social services to health spending was associated with better state health outcomes. 6 Another state-level study found that higher overall welfare spending was also associated with better health outcomes.…”

mentioning

confidence: 99%

Government Spending In Health And Nonhealth Sectors Associated With Improvement In County Health Rankings

McCullough

Leider

2016

Health Affairs

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There is little evidence to demonstrate the impact on local health outcomes of spending that occurs outside the health care sector. We leveraged novel data from the US Census Bureau to measure the independent impact of a community's health and nonhealth expenditures on a broad measure of overall health-the County Health Rankings-over time. Using lagged longitudinal models that accounted for correlations of health outcomes and expenditures within counties, we found significant positive associations between expenditures and County Health Rankings for seven of the fourteen expenditure categories examined: community health care and public health, public hospitals, fire protection, K-12 education, corrections, libraries, and housing and community development. These areas of social spending have modest but detectable positive associations with population health, whether or not they primarily target health. Achieving improved health outcomes through a culture-of-health ethos should involve the consideration of public expenditures in both health and other social service areas.

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confidence: 99%

Government Spending In Health And Nonhealth Sectors Associated With Improvement In County Health Rankings

McCullough

Leider

2016

Health Affairs

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“…Local departments are typically partially funded through local property taxes or through a dedicated public health revenue stream from local government. Although it is a substantial source of revenue for LHDs of any governance type, local government support of public health agencies is typically modest-about 3% of total local taxes, on average (72,85). State legislatures also fund local public health, typically through grants and contracts administered by the state health agency, general state fund support, and other dedicated revenue.…”

Section: Modern Structure Of Fundingmentioning

confidence: 99%

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

Leider

Resnick

Bishai

et al. 2024

Annual Review of Public Health

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The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.

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“…Because LHD revenues and any volatility associated with these may also be affected by external supply and demand factors, this study controlled for a number of community characteristics that have been, or may be, associated with LHD finances. 19,20,26,27 These included measures of community size and composition, health care availability and accessibility, and community wealth. All these variables may affect revenue availability, munificence, and stability, whether directly (eg, through their effects on the local tax base) or indirectly (eg, by shaping community demand for public health services).…”

Section: Control Variablesmentioning

confidence: 99%

Local Health Department Revenue Diversification and Revenue Volatility: Can One Be Used to Manage the Other?

Viall

Bekemeier

Yeager

et al. 2021

Journal of Public Health Management &Amp; Practice

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Objective: Revenue volatility-particularly in the form of sudden and significant reductions in funding-has been shown to negatively affect local health departments (LHDs) by impacting the amount and type of services delivered. This study examined the potential effectiveness of revenue diversification as a means of managing LHD financial risk. More specifically, we examine the relationship between revenue diversification and revenue volatility among LHDs in Washington State. Design and Setting: We applied fixed-effects linear regression models with robust standard errors to revenue data reported during 1998-2014 by all LHDs operating in Washington State. We also assessed the robusticity of our results to alternative specifications for revenue diversification and volatility. Main Outcome Measures: LHD revenue and revenue volatility. Results: Between 1998 and 2014, LHDs in Washington State were exposed to considerable upside and downside fiscal risks. While average revenue volatility was close to 0 (0.2%), observed values ranged from −35% to 63%. LHD revenues were already highly diversified: as measured using a reversed Herfindahl-Hirschman Index, diversification values ranged between 0.56 and 1.00. There is little evidence to suggest the existence of a statistically significant relationship between revenue diversification and volatility. Conclusions: Revenue volatility presents LHDs with important short-and long-term operational challenges. Our models suggest that revenue diversification did not reduce revenue volatility among Washington State LHDs in 1998-2014. Further research will need to examine whether revenue diversification reduces LHD financial risk in other settings. KEY WORDS: budget diversification, local health departments, public health finance, public health revenueT he National Academy of Medicine (previously, the Institute of Medicine) has characterized public health finance as a "complex and often ad hoc patchwork of funding streams with federal, state, local, and private sources that vary widely among communities and exhibit considerable

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Local Fiscal Allocation for Public Health Departments

Cited by 12 publications

References 28 publications

Government Spending In Health And Nonhealth Sectors Associated With Improvement In County Health Rankings

Government Spending In Health And Nonhealth Sectors Associated With Improvement In County Health Rankings

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels

Local Health Department Revenue Diversification and Revenue Volatility: Can One Be Used to Manage the Other?

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