Online Program

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

Tuesday, November 3, 2015

Betty Bekemeier, RN, PhD, FAAN, School of Nursing, Department of Psychosocial & Community Health, University of Washington, Seattle, WA
Justin Marlowe, PhD, CGFM, University of Washington Evans School of Public Affairs, Seattle, WA
Sharee Squires, PhDc, BSN, RN, Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA
Seungeun Park, MSN, RN, Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA
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.

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Public health administration or related administration
Public health or related public policy
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the nature of the variation in costs identified for foundational public health capabilities and for related services delivered in Washington State. Describe the factors that impact the cost of foundational public health capabilities and services and the implications of these impacts for practice- and policy-making.

Keyword(s): Public Health Administration, Funding/Financing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the study PI and a active, recognized public health systems researcher. I also have many years of experience in the practice-based research approach used in this study and with the population studied.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.