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Local Health Departments and Specific Maternal and Child Health Expenditures: Relationships Between Spending and Need

Bekemeier, Betty PhD, MPH, FAAN; Dunbar, Matthew PhD; Bryan, Matthew PhD, MS; Morris, Michael E. PhD, MPH, CPH

Journal of Public Health Management & Practice: November/December 2012 - Volume 18 - Issue 6 - p 615–622
doi: 10.1097/PHH.0b013e31825d9764
Original Articles

Objective: As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice–Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs.

Design: We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors.

Measures: Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with “need” and control variables.

Study Population: Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve.

Results: Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction.

Conclusions: Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.

This article examines relationships between local health department maternal and child health expenditures and local needs. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less need-based funding allocations.

Department of Psychosocial and Community Health, School of Nursing (Dr Bekemeier); Center for Studies in Demography and Ecology (Dr Dunbar) and Department of Biostatistics and Center for Biomedical Statistics (Dr Bryan), University of Washington, Seattle; and Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock (Dr Morris).

Correspondence: Betty Bekemeier, PhD, MPH, FAAN, Department of Psychosocial and Community Health, School of Nursing, University of Washington, Box 357263, Seattle, WA 98195 (bettybek@uw.edu).

Funding was provided by the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars Program (grant 68042), the RWJF Public Health Practice-Based Research Networks Quick Strike Research Funds Subaward (grant 32578), the University of Washington's van Hooser Gift Fund, and the Institute of Translational Health Sciences, supported by grant UL1RR025014 from the NIH National Center for Research Resources.

The authors declare no conflicts of interest.

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