Understanding Cost Variation in Public Health

For some time now our research group has studied geographic variation in public health spending across the U.S. (for examples see this paper and that paper), inspired by the great work that the Dartmouth Atlas group has produced over the decades regarding medical expenditure variation. We have produced, I hope, some rather interesting insights regarding the causes and health and economic consequences of this variation. But one issue that has long stymied us involves the underlying cost variation of public health activities.

It turns out that it is rather difficult to measure and compare the costs of implementing public health programs and policies across states and communities, due to the scarcity of comparable cost accounting data systems and surveys that break out state and local public health agencies and their activities from other units of government. As a result, we have very few empirical estimates about how the costs of public health delivery vary with the scope and scale of an agency’s activities, with structural characteristics of agencies and delivery systems, and (perhaps most importantly) with the characteristics of the population groups served, including their health needs and risks.

This is why I am so excited about a new series of 11 studies we recently launched through the Public Health PBRN Program, which are specifically designed to measure the costs of delivering selected public health services, and to analyze the public health system characteristics that drive variation in these costs. Funded by the Robert Wood Johnson Foundation, these projects will soon be filling some very important gaps in knowledge (and in methodology) needed to support conclusions about the cost-effectiveness and value of public health programs and policies.

Yesterday (spooky) we held the latest edition of a monthly virtual meeting among these projects – called Public Health Delivery and Cost Studies (DACS) – to help standardize and harmonize the methods being used for measurement and analysis. This standardization will allow us to make comparisons across studies and across the public health settings and services included in each study and PBRN research network. It will be a year or so before we see final results from these studies, but I hope to give regular updates on this blog about the progress and any insights along the way about measurement and analytic methodology.

For those of you attending the APHA Annual Meeting in Boston starting this weekend, we’ll be giving a few updates on DACS at Dr. Peggy Honore’s Public Health Finance Roundtable meeting on Sunday afternoon (BCEC Room 157C). And by the way, our full working inventory of APHA sessions on public health services & systems research is available here. Stay tuned for more empirical economics issues that surface at this meeting.

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4 thoughts on “Understanding Cost Variation in Public Health

  1. Pingback: The 141st Time is the Charm: Actionable Economics at the APHA Meeting | Public Health Economics

  2. Pingback: Economic Analysis and Quality Improvement in Public Health | Public Health Economics

  3. Pingback: Research and Public Health Innovation | Public Health Economics

  4. Pingback: The Economics of Implementing Population Health Strategies | Public Health Economics

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