Developing a tool for estimating local health departments' costs of providing public health services

The cost of providing a basic set of public health services necessary to protect the health of a population has not been well-described. Yet defining and describing the cost of these basic services is critical to public planning, policy, and assessment, particularly as local health departments (LHDs) suffer cuts to both programs and the public health workforce. The purpose of this research is to develop a tool for the estimation of service costs that can be readily implemented by finance staff in LHDs. To this end, we created a costing instrument for public health services by modifying and adapting the Substance Abuse Services Cost Analysis Program (SASCAP) cost instrument developed by RTI. Our instrument provides LHDs with a template to systematically compile their costs of providing public health services including both direct costs (e.g., labor, supplies, buildings, and equipment) and indirect costs (e.g., overhead costs). The instrument also asks for the number of services provided and/or clients served to allow for the calculation of the cost per unit of output produced. After having received input from select public health practitioners on the usability of our instrument, we will pilot the instrument in 16 LHDs in North Carolina in the spring/summer 2014. The focus of our pilot is on costing select environmental health services, such as childhood lead investigations and food and lodging inspections. In addition to presenting our costing instrument, we will also present preliminary data and share some early lessons learned. An in-depth understanding of the costs of providing public health services will allow public health officials to make decisions about the types and scope of public health services offered by their respective agencies, demonstrate additional funding needs, and evaluate the effect of partnerships and reorganization efforts on the cost and availability of public health services in their communities.