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Getting What You Pay For: Public Health Spending and the Performance of Essential Public Health Services

Mays, Glen P. PhD, MPH; McHugh, Megan C. MPA; Shim, Kyumin PhD; Lenaway, Dennis PhD; Halverson, Paul K. DrPH, MHSA; Moonesinghe, Ramal PhD; Honoré, Peggy DHA, MHA

Journal of Public Health Management and Practice: September-October 2004 - Volume 10 - Issue 5 - p 435–443
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Governmental spending in public health varies widely across communities, raising questions about how these differences may affect the availability of essential services and infrastructure. This study used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 to examine the association between public health spending and the performance of essential public health services. Results indicated that performance varies significantly with both local and federal spending levels, even after controlling for other system and community characteristics. Some public health services appear more sensitive to these expenditures than others, and all services appear more sensitive to local spending than to state or federal spending. These findings can assist public health decision makers in identifying public health financing priorities during periods of change in the resources available to support local public health infrastructure.

The study in this article used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests to examine the association between public health spending and the performance of essential public health services.

Associate Professor, Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Mays).

Health Analyst, Mathematica Policy Research, Washington, D.C. (McHugh)

Health Economist and Senior Fellow, Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia (Shim).

Branch Chief, State and Community Services Branch, Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia (Lenaway).

Professor and Chair, Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Halverson).

Statistician, Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia (Moonesinghe).

Director, Office of Health, Mississippi State Department of Health, Jackson; an Adjunct Assistant Professor, Medical University of South Carolina, Charleston; and Visiting Scholar, Rollins School of Public Health, Emory University, Atlanta, Georgia (Honoré).

Corresponding author: Glen P. Mays, PhD, MPH, Associate Professor, Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, #820, Little Rock, AR 72205 (e-mail: gpmays@uams.edu).

Research was funded by the Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention (Contract 200–2001–00122, Task Order 0005). An earlier version of this article was presented at the Eastern Economic Association Annual Meeting in Washington, D.C., in February 2004. The authors thank Ron Bialek, Jennifer Stanley, Laura Landrum, Natalie Perry, and Michael Grossman for comments provided on earlier versions of this article.

© 2004 Lippincott Williams & Wilkins, Inc.