A financial analysis of Maryland's LHDs expenditures and revenues before, during, and after the economic downturn

During the great recession and throughout recovery, local health departments (LHDs) have been among the hardest hit in governmental public health. In this presentation, we will report on the results of a financial analysis of six fiscal years of spending among Maryland's 24 LHDs. The analysis examines trends in overall spending, as well as program specific spending, and how direct-service generated revenue supported relatively stable revenue streams during times of budget difficulty (e.g., Communicable Disease Control). Using sources internal to the Department of Health and Mental Hygiene (DHMH), six years of data on local health department spending was collected, integrated, and analyzed for Maryland's 24 jurisdictions. To conduct the study, over 19,500 individual budget line items were categorized by revenue source and expenditure category. Overall, spending at Maryland's LHDs grew from approximately $100 per capita in FY2006 to $110 in FY2007 & 2008, and cut back to about $582 million or $100 per capita, in FY2011. Spending on maternal/child health ($21 per capita), substance abuse services ($14 per capita) , and communicable disease control ($10.5 per capita) round out the top three areas of expenditures, accounting for approximately 45% of spending in FY11. In FY2008, all of Maryland's LHDs were in the top quartile of spending nationwide, with 16 LHDs being in the top 10% of per capita spending nationwide (>$99.5), 13 LHDs in the top 5% (>$139), and 3 in the top 1% (>$284). This is due in large part to the high level of clinical care and direct service delivery performed by LHDs. As an example, substance abuse prevention and treatment services are handled by most LHDs in Maryland - and account for over 14% of total expenditures in FY2011. Relatively high levels of clinical care provision helped LHDs funding remain relatively stable over periods of budget decreases.