Corso Phaedra S, Ingels Justin B, Taylor Nathaniel, Desai Samir
University of Georgia.
EGEMS (Wash DC). 2014 Dec 22;2(4):1128. doi: 10.13063/2327-9214.1128. eCollection 2014.
Resources for public health (PH) are scarce and policymakers face tough decisions in determining their funding priorities. The difficulty of making these decisions is compounded by current PH accounting systems, which are ill-equipped to link fiscal resources to PH outcomes. This paper examines the types of revenues and expenditures, health services, and health outcomes that are being tracked at the local and state PH levels. The authors provide recommendations for strengthening the ability of local and state governments to link expenditures to PH outcomes, both within and across jurisdictions.
The source of revenue data for most local jurisdictions is the accounting systems used for the budgeting and auditing of fiscal activities, and these are primarily linked to specific PH programs. In contrast, expenditure data are mostly generic and typically span multiple PH programs with no link to specific PH activities. Many challenges exist to then link PH activities to health outcomes data, which are often collected through separate reporting systems at the local, state, and national levels. Policy change at the state level and implementation strategies that are standardized across local health departments are required to assess the costs and health outcomes of PH activities.
Information linking PH expenditures to health outcomes of PH services could greatly inform the decision-making process. This information will allow investments in PH to be better understood and will provide a strong foundation for the PH services and systems research community to understand variation and drive improvement. Ultimately, these data could be used to improve accountability at the local and state PH department levels.
公共卫生资源稀缺，政策制定者在确定资金优先事项时面临艰难决策。当前的公共卫生会计系统加剧了做出这些决策的难度，因为这些系统难以将财政资源与公共卫生成果联系起来。本文研究了地方和州公共卫生层面正在跟踪的收入与支出类型、卫生服务及健康成果。作者针对加强地方和州政府将支出与公共卫生成果相联系的能力提出了建议，包括在辖区内及跨辖区的联系。
大多数地方辖区的收入数据来源是用于财政活动预算编制和审计的会计系统，这些系统主要与特定的公共卫生项目相关联。相比之下，支出数据大多比较笼统，通常涵盖多个公共卫生项目，且与具体的公共卫生活动没有关联。要将公共卫生活动与健康成果数据联系起来存在诸多挑战，健康成果数据往往是通过地方、州和国家层面的单独报告系统收集的。需要州一级的政策变革以及地方卫生部门统一的实施策略来评估公共卫生活动的成本和健康成果。
将公共卫生支出与公共卫生服务的健康成果相联系的信息能够极大地为决策过程提供依据。这些信息将使对公共卫生的投资得到更好的理解，并为公共卫生服务和系统研究界理解差异并推动改进提供坚实基础。最终，这些数据可用于提高地方和州公共卫生部门层面的问责制。
