RESUMEN
Public health leaders are increasingly being asked to address adaptive challenges in the context of finite and often limited resources. Budgets and their associated resources create the financial framework within which public health agencies and organizations must operate. Yet, many public health professionals expected to undertake roles requiring this foundational knowledge and skills are not trained in the fundamentals of public finance and are ill-equipped for managing and monitoring funds. Graduate courses in schools of public health most often are focused on health care management and finance or private sector finance. To meet the needs of future public health leaders, it is critical that academic content builds capacity in management and finance focused on public health practice. This paper describes the development of a Doctor of Public Health program management and finance course designed to prepare future public health leaders. The course aims to build the knowledge and skills of doctoral-level students to recognize the inherent challenges of public health finance and the importance of cultivating and managing resources to improve public health practice and achieve strategic public health goals.
Asunto(s)
Salud Pública , Estudiantes , Humanos , Instituciones AcadémicasRESUMEN
CONTEXT: Leaders of government agencies are responsible for stewardship over taxpayer investments. Stewardship strengthens agency performance that is critical to improving population health. Most industries, including health care, and public enterprises, such as education, have policies for uniform data reporting and financial systems for the application of theoretical analytical techniques to organizations and entire systems. However, this is not a mainstreamed practice in local and state government public health. PROGRAM: The Public Health Uniform National Data System (PHUND$) is a financial information system for local health departments that advances the application of uniform practices to close financial analytical gaps. A 10-year retrospective overview on the development, implementation, and utility of PHUND$ is provided and supported by documented program and agency improvements to validate the analytical features and demonstrate a best practice. RESULTS: Benefits found from utilizing PHUND$ included reducing financial risks, supporting requests for increased revenues, providing comparative analysis, isolating drivers of costs and deficits, increasing workforce financial management skills, enhancing decision-making processes, and fostering agency sustainability to support continuous improvements in quality and population health. The PHUND$ financial data definitions in the data dictionary provided the structure needed for standardized data collection and confirmed the feasibility of a standardized public health chart of accounts. CONCLUSION: PHUND$ analysis provided evidence on the relationship between financial and operational performance, as well as informing strategies for managing risks and improving quality. Such analysis is critical to identifying financial and operational problems and essential to mitigating financial crisis, avoiding disruption of services, and fostering agency sustainability. PHUND$ additionally serves as an instrument that can guide development of standards that measure for agency sound financial management systems.
Asunto(s)
Informática/normas , Evaluación de Programas y Proyectos de Salud/normas , United States Public Health Service/economía , Florida , Humanos , Informática/instrumentación , Informática/estadística & datos numéricos , Gobierno Local , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Salud Pública/economía , Salud Pública/métodos , Estados UnidosAsunto(s)
Métodos Epidemiológicos , Adolescente , Adulto , Anciano , Algoritmos , Niño , Preescolar , Femenino , Florida , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mortalidad , Adulto JovenRESUMEN
In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.
Asunto(s)
Gastos en Salud/tendencias , Salud Pública/economía , Contabilidad , Recolección de Datos , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Estados UnidosAsunto(s)
Benchmarking/métodos , Difusión de Innovaciones , Federación para Atención de Salud , Administración en Salud Pública/economía , Indicadores de Calidad de la Atención de Salud/organización & administración , Recolección de Datos/normas , Financiación Gubernamental/tendencias , Guías como Asunto , Gastos en Salud , Investigación sobre Servicios de Salud , Humanos , Administración en Salud Pública/normas , Sociedades , Estados UnidosRESUMEN
A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.
Asunto(s)
Eficiencia Organizacional , Administración Financiera de Hospitales/normas , Financiación Gubernamental , Innovación Organizacional , Administración en Salud Pública/economía , Gestión de Riesgos , Benchmarking/métodos , Presupuestos/estadística & datos numéricos , Presupuestos/tendencias , Planificación en Salud Comunitaria/métodos , Planificación en Salud Comunitaria/normas , Difusión de Innovaciones , Recesión Económica , Administración Financiera de Hospitales/métodos , Guías como Asunto , Humanos , Liderazgo , Gobierno Local , Evaluación de Necesidades , Ohio , Estudios de Casos Organizacionales , Vigilancia de la PoblaciónRESUMEN
BACKGROUND: In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. METHODS: We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. RESULTS: Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. CONCLUSIONS: There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies.
Asunto(s)
Estado de Salud , Vigilancia de la Población , Práctica de Salud Pública/economía , Impuestos , Adolescente , Adulto , Anciano , Financiación Gubernamental , Humanos , Persona de Mediana Edad , Mississippi/epidemiología , Impuestos/economía , Adulto JovenRESUMEN
The US health care system has undertaken concerted efforts to improve the quality of care that Americans receive, using well-documented strategies and new incentives found in the Affordable Care Act of 2010. Applying quality concepts to public health has lagged these efforts, however. This article describes two reports from the Department of Health and Human Services: Consensus Statement on Quality in the Public Health System and Priority Areas for Improvement of Quality in Public Health. These reports define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. We describe how these developments relate to the Affordable Care Act and serve as a call to action for ensuring a better future for population health. We present real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health.
Asunto(s)
Práctica de Salud Pública/normas , Garantía de la Calidad de Atención de Salud/organización & administración , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Estados Unidos , United States Dept. of Health and Human ServicesRESUMEN
Since 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers' roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded to Hurricane Katrina in Mississippi and Louisiana. The data reveals a significant change in public health emergency response capacity as a result of federal funding. The role is still evolving, and many challenges remain, in particular, a clear articulation of the public health role in emergency response, the integration of the public health and emergency responder cultures, identification of the scope of training needs and strategies to maintain new public health emergency response skills, and closer collaboration with emergency response agencies.
Asunto(s)
Tormentas Ciclónicas , Socorristas , Rol Profesional , Sistemas de Socorro/organización & administración , Trabajo de Rescate , Humanos , Louisiana , Mississippi , Investigación CualitativaRESUMEN
Recognizing the public's health is the outcome of dynamic, adaptive, and complex systems of agencies; infrastructure, relationships, and interactions that dictate how to improve health outcomes; and reducing health risks in a population is based on systems thinking and evidence. New methods such as network analysis and public health practice-based research networks demonstrate the potential for new insight to our understanding of how systems and infrastructure influence population health. We examine advances in public health systems research since 1988 and discuss the relevance of this type of research to public health practice. We assess the current infrastructure for conducting public health systems research, suggest how the research infrastructure can be improved, and conclude with a discussion of how health reform in the United States will require research focused on understanding the adaptive complexity inherent in public health and health care systems and strengthening the systems research infrastructure.
Asunto(s)
Investigación sobre Servicios de Salud/métodos , Administración en Salud Pública , Práctica de Salud Pública , Reforma de la Atención de Salud , Investigación sobre Servicios de Salud/organización & administración , Calidad de la Atención de Salud , Estados UnidosRESUMEN
The allocation of resources for public health programming is a complicated and daunting responsibility. Financial decision-making processes within public health agencies are especially difficult when not supported with techniques for prioritizing and ranking alternatives. This article presents a case study of a decision analysis software model that was applied to the process of identifying funding priorities for public health services in the Spokane Regional Health District. Results on the use of this decision support system provide insights into how decision science models, which have been used for decades in business and industry, can be successfully applied to public health budgeting as a means of strengthening agency financial management processes.
Asunto(s)
Presupuestos/normas , Técnicas de Apoyo para la Decisión , Administración en Salud Pública/economía , Humanos , Programas Informáticos , WashingtónRESUMEN
BACKGROUND: The work reported here builds on the identification of public health financial management practice competencies by a national expert panel. The next logical step was to provide a validity check for the competencies and identify priority areas for educational programming. METHODS: We developed a survey for local public health finance officers based on the public health finance competencies and field tested it with a convenience sample of officials. We asked respondents to indicate the importance of each competency area and the need for training to improve performance; we also requested information regarding respondent education, jurisdiction size, and additional comments. Our local agency survey sample drew on the respondent list from the National Association of County and City Health Officials 2005 local health department survey, stratified by agency size and limited to jurisdiction populations of 25,000 to 1,000,000. Identifying appropriate respondents was a major challenge. The survey was fielded electronically, yielding 112 responses from 30 states. RESULTS: The areas identified as most important and needing most additional training were knowledge of budget activities, financial data interpretation and communication, and ability to assess and correct the organization's financial status. The majority of respondents had some postbaccalaureate education. Many provided additional comments and recommendations. DISCUSSION: Health department finance officers demonstrated a high level of general agreement regarding the importance of finance competencies in public health and the need for training. The findings point to a critical need for additional training opportunities that are accessible, cost-effective, and targeted to individual needs.
Asunto(s)
Personal Administrativo/normas , Competencia Profesional , Administración en Salud Pública/economía , Encuestas de Atención de la Salud , Humanos , Estados UnidosRESUMEN
The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.
Asunto(s)
Personal Administrativo/normas , Competencia Profesional/normas , Administración en Salud Pública/economía , Comités Consultivos , Estados UnidosRESUMEN
Scientific and policy debates following new genetic discoveries have been intense and emotional when they have involved questions about the causes of, and solutions for, racial and ethnic health disparities in the United States. The difference in prevalence of diseases, allele frequency and genotype frequency among racial/ethnic groups are well known. The genomic profile for a given disease could have different genetic variants for different racial/ethnic groups. Do these results indicate that we have to consider different genetic tests and different genomic medicine for different racial/ethnic groups? If we do this, what is the impact on ethnic and class disparities in health care services in the United States? Current advances in genetic medicine are very promising; however, we must consider the possible impacts of these findings on health disparities, and how genetic medicine can be extended to everyone, not just those who can pay the often high price. If genomic medicine is to be a valid and reliable technology for all citizens regardless of wealth, race, ethnicity, or other determinants of social disadvantage, public health policymakers have to consider a number of policy issues and implications.