Can Accreditation Work in Public Health? Lessons From Other Service Industries

Reviews the literature on the experiences and outcomes of existing accreditation programs in health and social service industries in order to derive implications about the potential benefits and costs of accreditation for public health agencies

Kentucky: Round 1 - State Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Kentucky's health benefit exchange has thus far been among the nation's leaders in successful implementation, its sustainability will depend on political leadership, the ability of supporters to mount successful public relations and constituent campaigns, and ongoing fiscal support. All these elements will be hotly contested in the next year

Measuring Progress to Comprehensive Public Health Systems, National Preparedness, and a Culture of Health

This update describes recent progress on two national health measurement initiatives: The National Health Security Preparedness Index and the National Longitudinal Survey of Public Health Systems. These longitudinal data sources offer valuable perspectives on how health security practices and public health delivery systems are changing across the U.S

Medicaid Crowd-Out of Other Public Health Spending: Modeling Economic & Health Effects

MOTIVATION: Thirty states are expanding Medicaid eligibility under the Affordable Care Act (ACA) as of 2015, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who enroll in Medicaid. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to channel their health-related spending to Medicaid rather than to other types of public health programs and policies. The ACA may exacerbate Medicaid’s tendency to crowd out other types of public health spending, possibly resulting in unintended, adverse effects on population health. OBJECTIVES: Using a unique longitudinal data series on governmental spending from the 1992-2014, this study: (1) estimates the degree to which state Medicaid spending complements or crowds out other state and local public health spending over time; and (2) uses crowd-out estimates in combination with estimates of service delivery and mortality effects from other studies to simulate the impact of ACA’s Medicaid expansions on public health financing, service delivery, and preventable mortality. DESIGN: A retrospective cohort design follows 50 states and approximately 2500 local public health agencies over the period 1992-2014 using periodic surveys of local agencies conducted by NACCHO combined with data from the U.S. Census of Governments (COG), Area Resource File, and state Medicaid reports. We construct separate measures of annual state Medicaid spending, state and local hospital spending, and state and local public health spending on a per capita scale. Fixed-effects and dynamic structural equation models are used to estimate the effects of Medicaid and hospital spending on public health spending, while controlling for a rich set of fiscal, demographic, socioeconomic, and health resources variables. Instrumental variables techniques are used to control for unobserved characteristics that simultaneously influence Medicaid and public health spending, using information on state Medicaid policy changes, Federal Medical Assistance Percentage (FMAP) changes, and public health governance characteristics as instruments. We estimate separate models at (1) the state level only and (2) both state and local level using hierarchical specifications. Population Studied: A total of 50 states and 2467 local public health agencies are examined over a 22 year period. RESULTS: Medicaid spending produces sizeable crowd-out effects on public health spending at both state and local levels during the study period. A 10% increase in state Medicaid spending was associated with a 4.1% reduction in state public health spending (

Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, and Crowd-Out

In this paper we estimate the causal impact of state Medicaid enrollment expansions and expenditures on state and local resources allocated to other public health programs and services. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions

Public Health Services & Systems Research and the Reforming U.S. Health System

This session reviews progress in the field of public health services & systems research (PHSSR), with a specific focus on findings that can inform the implementation and impact of health reform strategies on the U.S. public health system

Learning from Variation and Change: The 2016 Release of the National Health Security Preparedness Index

The 2016 release of the National Health Security Preparedness Index uses an improved computational methodology and validated set of measures to more accurately track national and state progress in protecting the public from the health effects of disasters, outbreaks and other large-scale emergencies. This presentation provides a preview of the new methodology and results

Public Health Services & Systems Research: Taking the Pulse of the Field

New research is continuing to reveal pathways for improving health and reducing health disparities at reasonable costs through multi-sector public health strategies

The National Longitudinal Survey of Public Health Systems: Selected Findings and Applications

This presentation reviews the National Longitudinal Survey of Public Health Systems and its applicability for monitoring the effects of the Affordable Care Act on public health delivery within the U.S

Public Health Spending, Preventable Outcomes, and Medical Cost Offsets: Questions for Health Reform

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care