Provision for Problematic Services and Local Public Health Spending

Currently, serious gaps exist in the ability of the nation to uphold the public's health and with the current state of the economy these gaps will only get worse, placing those who rely on services provided by their local health department at risk. This study examines the effect of provision for various problematic services on the distribution of local public health spending.

Data were obtained from the 2005 NACCHO and linked with 2005 U.S. Census Bureau's state level data and CMS and ARF county level data. Quantile regression was used to assess the provision of specific problematic services on public health spending per capita.

This study found that problematic services provided by LHDs increases with public spending but services contracted out are rare (<10% across all services). Contributions of a specific problem service to the level of public spending vary by problematic services and are different across quartiles. Controlling for covariates, provision of HIV screening by LHDs increase median public spending by 14% (p=0.04) but are statistically insignificant at 25th and 50th percentiles. Provision of STD screening increases public spending by 21-32% across quartiles and is higher at the upper quartile. However, treatment for STD only significantly increases public spending at lower quartile (25th). Screening for TB provided by LHDs contributes to a decreasing share of public spending, with spending increases by 28% and 11% at 25th and 50th percentiles but is insignificant at 75th percentile. Provision of tobacco control increases public spending by 13-17% across quartiles and is slightly higher at the upper quartile. Provision of WIC by LHDs increases public spending by 20-26% across quartiles. Provision of HIV or TB treatment has no statistically significant effect on public spending. Having services contracted out by LHDs generally have no effect/negative effect on public spending.