How much do we spend Creating historical estimates

Acknowledgements This work was funded in part by the de Beaumont Foundation. Dr. Leider

Public health finance is much more than CMS’ national estimates • Numerous articles on

Federal sources of data • Catalog of Federal Domestic Assistance (CFDA) • HHS-specific Tracking

© 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved.

Challenges with federal data • Many agencies – CDC included – do not publish

State health spending estimates • ASTHO (1970 s-1980 s and 2007 -present) • US

State health agency spending $ 250 $ 200 $ 150 $ 100 $ 50

Challenges with State estimates • Estimates from the Census and SHAs (by way of

Data sources for local health estimates • National Association of County and City Health

Billions Local level spending on community health care and public health $ 50 $

Per capita expenditures at LHDs and on nonhospital health services, 1993 -2013 x $

Non-hospital health spending (1972) © 2014, Johns Hopkins University. All rights reserved. © 2014,

Non-hospital health spending (2012) © 2014, Johns Hopkins University. All rights reserved. © 2014,

Where are we now? • Major national projects • Financial data for use in

Revised NHEA estimates Billions CMS Public Health activity estimate 80 70 60 50 40

Questions? © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University.

Slides: 22

Download presentation

How much do we spend? Creating historical estimates of public health expenditures in the US at the federal, state, and local levels JP Leider, Beth Resnick, David Bishai, F. Douglas Scutchfield Johns Hopkins Bloomberg School of Public Health University of Kentucky College of Public Health

Acknowledgements This work was funded in part by the de Beaumont Foundation. Dr. Leider was a consultant to the de Beaumont Foundation. The authors thank Lava Timsina for processing historical financial data, Mac Mc. Cullough for use of historical local data, the US Census Bureau for provision of data, and to the Johns Hopkins State Health Expenditure Dataset team for their support of the project. The authors have nothing to disclose © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

$ 90 $ 80 $ 70 $ 60 $ 50 $ 40 $ 30 $ 20 $ 10 $- 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Billions Public Health Activity estimates (from National Health Expenditure Accounts) © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Public health finance is much more than CMS’ national estimates • Numerous articles on public health finance • Datasets exist for • • Federal State Local National • Special datasets/projects: • PHAST, DACS, SHED, UCA and more © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Federal sources of data • Catalog of Federal Domestic Assistance (CFDA) • HHS-specific Tracking Accountability in Government Grants System (TAGGS) • Data. gov • Office of Management and Budget historical • Historical records exist in the now-defunct Consolidated Federal Funds Report • Both CDC and HRSA offer grant funding profiles for recent years • But how to define public health? © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Challenges with federal data • Many agencies – CDC included – do not publish the final location and disposition of sub-awards • CDC will sometimes directly award grants to local health departments that may also receive additional CDC funding via pass-through funds from the state health agency • Unclear if databases reflect spending under the agency’s authority versus both agency spending and other federal sources of funds, (e. g. , the Prevention and Public Health Fund) • Further complicated by datasets that may include or exclude mandatory and/or discretionary spending, and whether such budgetary details are explicitly identified to the data user © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

State health spending estimates • ASTHO (1970 s-1980 s and 2007 -present) • US Census • Trust for America’s Health © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

State health agency spending $ 250 $ 200 $ 150 $ 100 $ 50 $19741976197819801982198419861988199019921994199619982000200220042006200820102012 State spending SHA spending Unreported © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Challenges with State estimates • Estimates from the Census and SHAs (by way of ASTHO) are difficult to reconcile • Where ASTHO collects data on SHAs alone, Census collects it on all state agencies performing public health activities • Census collects data on all health activities (including, separately, Medicaid and public hospital spending) means the scope and scale of spending is quite different between the two estimates. • Increased proportion of state-level non-hospital health spending is going toward personal health care activities – likely especially toward behavioral healthcare and outpatient community health care. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Data sources for local health estimates • National Association of County and City Health Officials • US Census Bureau © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Billions Local level spending on community health care and public health $ 50 $ 45 $ 40 $ 35 $ 30 $ 25 $ 20 $ 15 $ 10 $5 $1970 1975 1980 1985 1990 1995 © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015, 2000 2005 2010

Per capita expenditures at LHDs and on nonhospital health services, 1993 -2013 x $ 120 $ 100 $ 80 $ 60 $ 40 $ 20 $1993 LHD Mean 1997 2005 County area Mean 2008 LHD Median © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015, 2010 2013 County area Median

Where are we now? • Major national projects • Financial data for use in cost-benefit analyses • Significant challenges • Are our official estimates correct? • Spoilers: No. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,

Revised NHEA estimates Billions CMS Public Health activity estimate 80 70 60 50 40 30 20 10 2000_)2001_)2002_)2003_)2004_)2005_)2006_)2007_)2008_)2009_)2010_)2011_)2012_)2013_) Johns Hopkins University. All rights reserved. Updated range© 2014, of PHAE (JHSPH) Official PHAE (NHEA) © 2014, Johns. Hopkins. University. Allrightsreserved. © 2015,