State public health agency expenditures: categorizing and comparing to performance levels

For optimal effectiveness, assessments of public health agency and system performance should include analysis to measure the amount of financial resources consumed to achieve performance levels. This pilot study was conducted to test a methodology in a state health department for comparing financial resources consumed to performance scores in each of the 10 Essential Public Health Services categories. An additional feature was to quantify the percentage of total agency expenditures utilized for administrative functions as well. The allocation of all fiscal year 2004 expenditures to the 10 Essential Public Health Services and administration categories was based on assessments of employee job functions and scope of services performed under agency contracts. Performance scores were obtained through a 2-month process of completing self-assessment surveys with system partners using the National Public Health Performance Standards Program Assessment Instrument. Investigators found no clear consistency between performance scores and agency expenditure levels. Two categories, essential service 5 (develop policies and plans) and essential service 10 (research), did have low performance and low expenditure levels. Overall though, categories with high performance scores consumed low percentages of agency expenditures and expenditure patterns were relatively high in categories with low performance scores. The study did quantify that the percentage of expenditures in the administration category was low compared to previous studies in other health departments. This knowledge was particularly useful for informing policymakers.