Submitted on Mon, 2016-01-18
By SMART Health Claims

Researchers from City University of New York (CUNY) School of Public Health examined 5 decades of public health funding data and found that spending rose consistently from 1960 to 2002, but fell by 9.3% after the economic recession of 2008. 

If funding had remained at the 2008 level, $40.2 billion would have been directed to public health programs. The study further concludes that public health spending will continue its 20-year decline until the year 2023, falling to 2.4% of the total health expenditure.

Language from the 2010 Affordable Care Act (ACA) indicated a positive shift for public health funding. Specifically, the ACA established the Prevention and Public Health Fund, which aimed to provide sustained national investments in prevention and public health. In reality, public health agencies received less than half of the funding they were promised, as funds were later reallocated to other areas of healthcare and cut, due to sequestration.

“The Affordable Care Act originally promised a $15 billion boost in public health funding. However, a 2012 law cut funding for the [ACA’s] Prevention and Public Health Fund by $6.25 billion. Sequestration, which cut federal spending across the board beginning in 2013, reduced it even further.” -  Drs. David Himmelstein and Steffie Woolhandler, authors of the study.


Top Findings of the “Public Health’s Falling Share of US Health Spending” study include:

  • Public health spending per head of population rose from $39 in 1960 (after inflation) to $281 in 2008, but it has fallen by 9.3% since then

  • If funding had remained at the 2008 level of $281 per capita, an extra $40.2 billion would have been devoted to public health between 2009 and 2014.

  • Public health's share of total health expenditure rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014. It is projected to fall to 2.40% in 2023.

  • The growth in spending over these decades was primarily driven by an increase in state and local government money, which accounted for between 80 to 90 percent of the influx

As a direct result of underfunding, health departments have eliminated nearly 52,000 jobs and were forced to make cuts to vital health services. The unfortunate result is an overall inability for health departments to provide essential services to their communities.

"Since 2008, local health departments across the country have eliminated 51,700 jobs and served 35% fewer patients"

The Consequence of Underfunding Public Health

The CUNY study paints a broad picture of public health funding over a span of more than 50 years. It tells of a prosperous time of stability and consistent growth where public health agencies expanded deeper into their communities. It also describes a time when it all collapsed, with drastic cuts having equally drastic results.

What the statistics do not show are the public health nurses who lost their jobs or the elderly couple who are not able to receive health services from their county health department anymore. These cuts have weakened our public health infrastructure and put our communities at risk.

A 2015 NACCHO local health department survey describes the actual impact of underfunding. Since 2008, local health departments across the country have eliminated 51,700 jobs and served 35% fewer patients. The study reveals that most departments are cutting their budgets, eliminating positions and reducing their services.

More and more, our communities’ most underserved populations are being forced to go elsewhere for the same health services they once received at public health departments.

"Today, 9 out of 10 public health agencies are actively billing Medicaid, Medicare and private health insurance companies for health services."

A Bleak Future for Local Health Departments?

Public health funding will continue to decline. The CUNY study projects a 20-year decline in public health spending to reach 25% by the year 2023. The NACCHO study reports that most local health department personnel expect that their budgets will be cut again for 2016.

Public health leaders have no other option than to take matters into their hands. Today, 9 out of 10 public health agencies are actively billing Medicaid, Medicare and private health insurance companies for health services. As the CDC Director, Dr. Thomas Frieden states, “They are realizing they must do so to survive.”

This new era in public health means that organizations must implement private business practices to compensate for chronic underfunding from the traditional source. Now, the goal is to find new ways to increase and maximize their billing and revenue programs to sustain their services.

In stark contrast to the bleak present is a promising future. Meeting the challenge, public health professionals are building smarter, more efficient, more effective agencies that provide services specific to their communities. In spite of their continued lack of support, our public health officials may very well emerge with stronger and more effective organizations because of these funding cuts.



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