Jason M. Orr, University of Minnesota, Minneapolis, Minnesota.
Jonathon P. Leider, University of Minnesota.
Health Aff (Millwood). 2023 Mar;42(3):374-382. doi: 10.1377/hlthaff.2022.01234.
The US governmental public health system, which includes federal, state, and local agencies, is seen by many observers as having a money problem, stemming from a lack of resources. During the COVID-19 pandemic, this lack of resources has had unfortunate consequences for the communities that public health practice leaders are expected to protect. Yet the money problem is complex and involves understanding the nature of chronic public health underinvestment, identifying what money is spent in public health and what the country gets for it, and determining how much money is needed to do the work of public health in the future. This Commentary elucidates each of these issues and provides recommendations for making public health services more financially sustainable and accountable. Well-functioning public health systems require adequate funding, but a modernized public health financial data system is also key to the systems' success. There is a great need for standardization and accountability in public health finance, along with incentives and the generation of research evidence demonstrating the value of and most effective delivery for a baseline of public health services that every community should expect.
美国政府公共卫生系统包括联邦、州和地方机构，许多观察人士认为该系统存在资金问题，其根源在于资源匮乏。在 COVID-19 大流行期间，这种资源匮乏给公共卫生实践领导人本应保护的社区带来了不幸的后果。然而，资金问题很复杂，涉及到理解长期公共卫生投资不足的性质，确定在公共卫生方面花费了多少钱以及国家从中获得了什么，以及确定未来开展公共卫生工作需要多少资金。本评论阐述了这些问题中的每一个，并为使公共卫生服务在财务上更具可持续性和问责制提供了建议。运作良好的公共卫生系统需要充足的资金，但现代化的公共卫生财务数据系统也是该系统成功的关键。公共卫生财政需要标准化和问责制，以及激励措施和研究证据的产生，以证明每个社区都应该期望的基本公共卫生服务的提供方式和最有效的交付方式的价值。
