Peggy A. Honoré

Creating A Framework For Getting Quality Into The Public Health System

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.

Recent Advances in Public Health Systems Research in the United States

Recognizing the publics 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.

Accelerating the Production and Application of Evidence for Public Health System Improvement: the Search for New Frontiers

The new journal Frontiers in Public Health Services and Systems Research provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems.

CREATING FINANCIAL TRANSPARENCY IN PUBLIC HEALTH: EXAMINING BEST PRACTICES OF SYSTEM PARTNERS

Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.

Practices in public health finance: an investigation of jurisdiction funding patterns and performance.

A field of study for public health finance has never been adequately developed. Consequently, very little is known about the relationships, types, and amount of finances that fund the public health system in America. This research was undertaken to build on the sparse knowledge of public health finance by examining the value of performance measurement systems to financial analysis. A correlational study was conducted to examine the associations between public health system performance of the 10 essential public health services and funding patterns of 50 local health departments in a large state. The specific objectives were to investigate if different levels and types of revenues, expenditures, and other demographic variables in a jurisdiction are correlated to performance. Pearson correlation analysis did not conclusively show strong associations; however, statistically significant positive associations primarily between higher levels of performance and jurisdiction taxes per capita were found.

Decision science: a scientific approach to enhance public health budgeting.

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.

Applying principles for outcomes-based contracting in a public health program.

A national movement is underway for government agencies and their program implementation partners, such as contractors and grantees, to explicitly demonstrate the benefits acquired from the expenditure of public funds. Given such expectations, agencies have adopted initiatives, such as outcomes-based contracting, as quality improvement tools to facilitate performance improvements and to document results. When using outcomes-based contracting methods, payments are linked to accomplishment of mutually agreed upon results. Outcomes are not defined in terms of what is performed, but on the impact of what has been achieved. This case study documents the implementation of some fundamental principles for outcomes-based contracting in a state health department community partnership program. Results are also presented from an interview of contractors that participated in this new contracting process. Interview objectives were to document the impact of outcomes-based contacting on building collaborations and improving accountability. Results revealed perceptions of a highly collaborative relationship between the agency and contractors where contractors viewed outcomes-based contracting as improving accountability by focusing on results, establishing and monitoring performance targets, and facilitating contractor flexibility. Respondents also indicated strongly that under this contracting method, they utilized the funding more effectively by linking it with other community investments.

Public Health Financial Management Competencies

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.

The effects on population health status of using dedicated property taxes to fund local public health agencies

BackgroundIn 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.MethodsWe 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.ResultsLevying a dedicated public health tax for counties with per capita income above

State public health agency expenditures: categorizing and comparing to performance levels.

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.ConclusionsThere 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.