Estimated Expenditures for Essential Public Health Services --
Selected States, Fiscal Year 1995
Essential public health services are activities that public
health departments and other partners undertake to protect and
ensure the health of the public. To characterize expenditures for
those services and to distinguish within them expenditures for
personal health-care services from community-based health services
directed toward populations, the Public Health Service (PHS) and
the Public Health Foundation surveyed senior health officials in
eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode
Island, Texas, and Washington {combined 1995 population: 57.8
million} *) (1). This report summarizes the results of that survey,
which indicate that spending on community-based health services is
a small proportion of spending on essential services and an even
smaller proportion of total health-care expenditures.
The eight states were selected to reflect geographic and
population diversity and the scope of public health
responsibilities and differing organizational relations among their
health agencies. Senior public health officials in each state used
standard forms and objectives to provide state-specific total
public health expenditures and expenditures associated with the 10
essential public health services (see box(Table_1)).
Expenditures
for the sixth essential service were subdivided: linking persons to
needed personal services was separated from assuring the provision
of
care when otherwise unavailable. Respondents provided estimates of
expenditures by public health, mental health, substance abuse, and
environmental agencies for essential services during fiscal year
1994 or 1995. Mental health expenditures were based on fiscal year
1993 data collected by the National Association of State Mental
Health Program Directors.
During 1994 or 1995, the eight states spent an estimated $8.0
billion on essential public health services; personal health care
accounted for $5.5 billion (69%) of this total. Per capita
expenditures for essential public health services by state and
local public health agencies ranged from $51 to $219 (median:
$123). Of these expenditures, per capita expenditures for personal
health-care services ranged from $29 to $169 (median: $72). Mental
health expenditures constituted 42%-88% (median: 70%) of personal
health-care expenditures. Expenditures for community-based health
services were $16 to $53 (median: $31) per capita or 0.6% to 1.9%
(median: 1.2%) of total 1993 health-care expenditures (2) in each
of the eight states.
Reported by: J Dillenberg, Arizona Dept of Health Svcs. C Atchison,
Iowa Dept of Public Health. E Baumgartner, Louisiana Dept of Health
and Hospitals. B DeBuono, New York State Dept of Health. E Hill,
Oregon Health Div. P Nolan, Rhode Island Dept of Health. D Smith,
Texas Dept of Health. B Miyahara, Washington State Dept of Health.
Public Health Foundation, Washington, DC. Health Resources and Svcs
Administration, and Office of Disease Prevention and Health
Promotion, Public Health Svc; Office of Public Health and Science,
US Dept of Health and Human Svcs.
Editorial Note
Editorial Note: The findings in this report indicate the
predominance of personal health services in the public health
systems of the states participating in this survey: more than $2 of
every $3 spent by the eight states on essential public health
services was for personal health-care services. Spending for
population-based services accounted for only 1% of total
health-care expenditures. These findings provide baseline estimates
of public health expenditures, which can be used to develop policy
and determine resource allocations.
The findings in this report are subject to at least three
limitations. First, the estimated expenditures are based on data
from a small, nonrandom sample of states that may not be
representative of all states. In particular, the availability and
use of resources for essential public health services may vary in
relation to public priorities, revenue sources, and other factors.
Second, although the essential services were explicitly defined,
there were state-specific differences in statutory responsibilities
and organization of state public health agencies that in turn were
associated with variations in expenditures for and interpretations
of the essential public health services. Finally, the ability of
the eight states to compile local expenditure data varied. PHS is
refining the methods used to estimate expenditures for essential
public health services and will directly estimate local essential
public health service expenditures.
References
Public Health Foundation. Measuring expenditures for essential
public health services. Washington, DC: Public Health
Foundation,
1996.
Alecxih KL, Rutkin D. State-level estimates of health-care
expenditures. Arlington, Virginia: Lewin-VHI, 1993.
Three states reported expenditures for 1994 and six for 1995.
Illinois also was surveyed but is excluded from all analyses
reported here because of missing local health department data. Table_1 Note:
To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
Public Health Responsibilities and Essential Public Health Services, 1994
Public Health Responsibilities:
-- Prevent epidemics and the spread of disease.
-- Protect against environmental hazards.
-- Prevent injuries.
-- Promote and encourage healthy behaviors and mental health.
-- Respond to disasters and assist communities in recovery.
-- Assure the quality and accessibility of health services.
Essential Public Health Services:
-- Monitor health status to identify and solve community health problems.
-- Diagnose and investigate health problems and health hazards in the
community.
-- Inform, educate, and empower people about health issues.
-- Mobilize community partnerships and actions to identify and solve
health problems.
-- Enforce laws and regulations that protect health and ensure safety.
-- Link people to needed personal health services and assure the provision
of health care when otherwise unavailable.
-- Assure a competent public health and personal health-care workforce.
-- Evaluate effectiveness, accessibility, and quality of personal and
population-based health services.
-- Develop policies and plans that support individual and community health
problems.
-- Research for new insights and innovative solutions to health problems.
Source: Essential Public Health Services Work Group.
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