Use of fees to fund local public health services

Local health departments are charged with the responsibility of protecting the public's health in small jurisdictions. While mandated responsibilities of local health departments have increased over the years, their resources have remained limited, making it difficult for some to deliver essential services. Although health departments commonly charge fees for certain services, many may not recognize such fees as a viable source of funding.

The objective of this project was to examine fees charged for public health services provided by local health departments in Western Massachusetts and to determine the extent to which health departments are covering expenses incurred during service provision. A comparative cost analysis was conducted. The fees charged for selected services were compared with estimates of the costs of providing those services. Reasons for variability of fees across health departments were explored.

This study found enormous variation both in the types of services for which health departments charge fees and in the levels of fees charged. For example, fees for a percolation test ranged from $25 to $300. Fee-cost comparisons indicated that the fees set by most health departments did not cover the expense of service provision. Some fees were set as much as $600 below costs.

These results suggest that considerations other than costs of service provision factor into the setting of fees by local health departments. Given that local health departments have limited funding, they may want to more carefully consider costs of service provision while setting fees.