25 Years of Publication: Twelve Major Themes: Commentary
The Journal of Public Health Management & Practice (JPHMP) dominates the publishing field with literature on finance topics specific to the public health system. Over its 25-year history, the JPHMP has published 3 themed issues (2004, 2007, and 2012) on public health finance in addition to finance-related articles in various other issues. This commentary highlights contributions made in many of those articles that can be found in the JPHMP Finance Collection at https://journals.lww.com/jphmp/pages/collectiondetails.aspx?TopicalCollectionId=2. The distinguished and diverse group of authors contributing articles in the 3 themed issues included the late Senator Edward M. Kennedy along with academics and practitioners from across multiple sectors of the profession. In his 2007 article, Senator Kennedy proclaimed health care to be a right for all people and that adequate public health funding was essential to the health and security of the country.
In the 2007 special issue, public health finance was defined as a field of study that examines the acquisition, utilization, and management of resources for the delivery of public health functions and the impact of these resources on population health and the public health system. In that issue and in keeping with the definition, public health finance was described as an economic concept relevant to guiding the acquisition and utilization of resources. Equally as important though, public health finance was described as a profession where practitioners needed workforce education and training on financial management and other related concepts applied directly to the field of public health.
While gaps in workforce skills and competencies is a stand-alone theme, this deficiency has relevance and significant negative implications on finance practices in public health as well. In 2009, the JPHMP published a comprehensive set of financial management competencies as a guide for building workforce knowledge, skills, and capabilities. It also serves as a tool for developing financial management job descriptions and career planning.
Perhaps, a model to illustrate achievements when the workforce has appropriate business and financial skills can be found in the 2004 article on the creation of the Florida Association of County Health Department Business Administrators (Florida Business Association) in 1985. Based on personal observations by this author and others familiar with financial systems across public health, Florida was first in creating the most comprehensive financial reporting systems in the country. The system was designed by public health practitioners with the business and financial skills to understand what was needed to produce complex analysis of public health funding in the state. Practitioners at both the state and local levels collaboratively led the design of the system and, consequently, Florida is able to cost services down to the per client level while also measuring against state unit cost benchmarks. The Florida Business Association also includes training and mentoring features that are critical to building, sustaining, and updating skills and reflects the values for professionalizing the workforce that can be found in other industries including health care and education. A 2007 article in the JPHMP provided results of an examination of finance and workforce best practices by system partners. Results showed that the Florida model for training, skills development, and system innovation was consistent with other sectors. It should be noted as well that in some other state and local public health agencies (eg, Ohio, West Virginia, Washington), progress is being made with demonstrating leadership around system-wide analysis on financing topics.
The JPHMP is oriented to the practice of public health. In keeping with its initial position in 1995, readers of the JPHMP over the years were introduced to finance-related innovations in support of public health practice. Examples include innovations using:
- Decision science techniques for developing scientific models for planning and budgeting;
- Outcomes-based contracting to promote resource utilization effectiveness and efficiencies;
- Methods in the Public Health Uniform National Data System (PHUND$) that confirmed the feasibility of developing a uniform chart of accounts;
- Financial forecasting techniques to better project revenue trends;
- Strategies to enhance the design of public health funding formulas;
- Methodologies in Georgia for developing stat-ewide cost reports to enhance reimbursements and costing of basic population-based public health services;
- Strategies from Ohio and Illinois for agency turn-arounds, retrenchments, and reorganizations;
- Methods for building equity into funding strategies;
- Uniform quantitative analytical techniques applied directly to the practice of public health by practitioners through a Web-based platform; and
- Metrics to enhance Public Health Accreditation Board (PHAB) accreditation standards for measuring agency financial management systems and overall financial sustainability.
Interest in public health finance topics continues to attract researchers and practitioners. 2018 marked the 14th anniversary of the Public Health Finance Roundtable (Roundtable) held annually since 2005 as an adjunct event of the American Public Health Association Annual Meeting. The JPHMP Editor-in-Chief, Lloyd Novick, MD, demonstrated his sincere interest in public health finance by attending the first Roundtable in 2005 and has attended several others throughout the years. A sample of finance-related topics at the 2018 Roundtable focused on the integration of public health and medical interventions to reduce cost and improve quality in:
- Patients with sickle cell disease;
- Pregnancy outcomes; and
- Maternal mortality.
Topics such as these were chosen especially given the increased focus on population health improvement since passage of the Affordable Care Act (ACA). The focus on population health improvement is also aligned with the definition of public health finance. As public health finance matures, greater focus by the research community should be on the financial impacts of integrating medical and public health interventions to reduce the economic burden of disease and social factors that drive costs across the system in both health care and public health. Increased efforts beyond descriptive research is also needed. Findings that can translate into actionable strategies across the system will support goals of the ACA. The accessibility of public health financial data is imperative to support the research. Efforts to make data availability a shared goal between the research and practice community will greatly support progress.