Unit costs of Foundational Public Health Programs and Capabilities for local public health systems….and what factors drive variation

Research Objective. Despite tremendous national efforts to advance public health system performance, the effectiveness of public health systems continues to be undermined by “profoundly misaligned” financing systems. Our objectives were to: 1) determine estimated costs per unit of service for foundational public health programs and capabilities in Washington (WA) State; and 2) determine how community factors influence costs and variation regarding these activities. 

Methods. We gathered administrative data on local spending from all 35 Local Health Jurisdictions (LHJs) in WA from 2009-2013 and linked these data with related public health service statistics and county-level socio-demographics. We then estimated drivers of variation in unit costs of foundational public health capabilities and services. We refined our models with nuanced, LHJ-level estimates of costs of foundational capabilities and services, based on additional original data collected through a cost estimation instrument completed by a stratified sample of ten LHJs.

Results. Scale economies appear to be reached in key capabilities such as assessment and business competencies. However, there is little evidence of scale economies for foundational services like communicable disease and chronic disease prevention. Findings also suggest gaps between current and needed spending around certain foundational capabilities and services—gaps that are widest among jurisdictions with higher poverty levels.

Conclusions. Economies of scale can be reached among foundational capabilities, but increased poverty appears to influence need among LHJs in terms of many costs. Study findings will provide evidence to help assure a minimum package of effective public health services in every community.