Mays Glen P, Smith Sharla A
Department of Health Policy & Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Health Serv Res. 2009 Oct;44(5 Pt 2):1796-817. doi: 10.1111/j.1475-6773.2009.01014.x. Epub 2009 Aug 17.
To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.
Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.
A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.
The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.
The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.
研究公共卫生机构支出水平在不同社区以及不同时间的变化程度，并确定这种变化的机构和社区相关因素。
美国县市卫生官员协会在1993年、1997年和2005年对全国2900个地方公共卫生机构进行的三次横断面调查，并与同期的人口统计学、社会经济特征和卫生资源信息相联系。
采用纵向队列设计分析1993年至2005年间社区层面人均公共卫生机构支出的变化和差异。使用面板数据的多元回归模型来估计支出、机构特征、卫生资源和人口特征之间的关联。
支出最高的20%的社区，其公共卫生机构支出水平比最低五分之一的社区高出13倍以上，并且在调整人口统计学和服务组合差异后，大部分这种差异仍然存在。地方卫生委员会和分散的州-地方行政结构与较高的支出水平以及较低的支出减少风险相关。地方公共卫生机构支出与当地医疗支出呈负相关。
决定向地方机构资金流动的机制可能使一些社区在为公共卫生活动获取资源方面处于不利地位。
