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Novel financing and delivery needed to implement recommended public health services

A publication from University of Kentucky College of Public Health investigators estimates the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. The resulting publication by Dr. Cezar Brian B. Mamaril and  Dr. Glen P. Mays  appears in Health Services Research.

The investigators note that a 2012 report from the Institute of Medicine identified two fundamental barriers to improving the nation’s public health system: (1) lack of agreement on a core set of public health capabilities that should be present in every U.S. community and (2) lack of knowledge about the resources required to implement these capabilities. In response to these recommendations, the Robert Wood Johnson Foundation commissioned an expert panel in 2013 to work on identifying components of a national “minimum package” of public health services and capabilities.  A cost estimation workgroup was also convened to recommend a methodology for estimating the resources required to fully implement the needed services using a relatively rapid and low-cost strategy that could generate estimates with an acceptable level of precision.

A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. Mamaril et al. used an implementation attainment scale to estimate costs of fully implementing FPHS. They used data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014–2015.

Investigators found that the average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Thus, the authors conclude that Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation.