Address correspondence to Glen P. Mays, Ph.D., M.P.H., Professor and Chairman, Department of Health Policy & Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #820, Little Rock, AR 72205; e-mail: firstname.lastname@example.org. Sharla A. Smith, M.P.H., is with the Department of Health Policy & Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
Geographic Variation in Public Health Spending: Correlates and Consequences
Article first published online: 17 AUG 2009
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 5p2, pages 1796–1817, October 2009
How to Cite
Mays, G. P. and Smith, S. A. (2009), Geographic Variation in Public Health Spending: Correlates and Consequences. Health Services Research, 44: 1796–1817. doi: 10.1111/j.1475-6773.2009.01014.x
- Issue published online: 1 SEP 2009
- Article first published online: 17 AUG 2009
- Public health spending;
- population health;
- practice variation
Objectives. To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.
Data Sources and Setting. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.
Study Design. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.
Principal Findings. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.
Conclusions. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.