Measuring state expenditures for core public health functions.

In 1993, the U.S. Public Health Service, with the assistance of the Public Health Foundation (PHF), launched a pilot study to develop state and national expenditure estimates for the core functions of public health. The core public health functions selected for the data collection effort were (1) health-related data, surveillance, and outcomes monitoring; (2) investigation and control of diseases, injuries, and response to natural disasters; (3) immunizations, family planning, and STD and TB clinical services; (4) protection of environment, housing, food, water, and the workplace; (5) laboratory services; (6) public information and education and community mobilization; (7) targeted outreach and linkage to personal services; (8) accountability/quality assurance; (9) training and education; and (10) leadership, planning, policy development, and administration. State health officials from Connecticut, Iowa, Missouri, Oregon, and Rhode Island helped develop a methodology and a set of guidelines for estimating expenditures on core functions and used this methodology to report expenditure data. Three additional states--Illinois, New York, and Texas--joined in a second phase of the pilot study, one that included collecting data on personal health services and total agency expenditure data. The eight states' combined per capita core function expenditures were $44 in fiscal year (FY) 1993. This included expenditures by state and local public health agencies and state substance abuse, mental health, and environmental health agencies. Expenditures for core public health functions accounted for 27% of these agencies' total expenditures. The largest core function expenditure accounting for approximately 30% of the total was for the protection of environment, housing, food, water, and the workplace. Extrapolating the eight states' expenditure estimates to the national level, spending for core public health functions in FY 1993 totaled $11.4 billion, or 1.3% of total U.S. health spending. The pilot project demonstrates that with appropriate guidance, including an estimating methodology and uniform definitions, categorical program data can be reported by function. The results of the data collection effort also demonstrate the potential utility of examining expenditures by core functions for state planning and policy making. The methodology allows states to distinguish core functions from other responsibilities, providing states with quantified information useful for reform efforts.