Grant Description: How can the value of governmental public health systems (GPHSs) be defined and measured? The GPHS is a state and local governmental apparatus designed to assess and respond to threats to the public’s health through population-based and individual health services. The researchers examined how other public or quasi-public entities define and measure value; the methodologies used to measure value; the criteria for determining and measuring value; and how measuring the value of these services will affect other important dimensions of public health systems, such as accountability. The objective of this study was to develop ways for policymakers to incorporate value measures for governmental public health system activities into resource allocation decisions.
Policy Summary: Governmental public health systems (GPHS), the state and local governmental apparatus designed to assess and respond to threats to the public’s health, face budgetary constraints and chronic underfunding. To help GPHS efficiently allocate scarce resources and demonstrate measurable contributions to the population’s health, this study set out to explore measuring the value of public health systems. The methodology for the study consisted of: 1) several literature syntheses focusing on measurement techniques in health economics and public health; 2) economic evaluation analyses of how other public and quasi-public systems define and measure value; and 3) semi-structured interviews with 46 national, state, and local public health practitioners, policymakers, and academics to gather information on participants’ views of defining and measuring the value of GPHS. Results from this study indicate that the methods for measuring value discussed in the public health and health economics literature do not match the real-world practice of measuring value in public health settings. Further, the literature on other sectors lacks definitions or frameworks that can be easily extrapolated to public health. The interviews revealed that, on occasion, public health practitioners have used cost-accounting, performance-based contracting, logic models, performance standards, and output numbers of services provided to measure value. However, respondents discussed concerns with defining and measuring value. The most common challenge mentioned by interview respondents was the lack of core data sets and agreement on outcome measures. Other key concerns were the lack of staff resources and limited knowledge of how to use resources effectively. Overall, attribution was identified as the largest barrier to measuring value, namely the inability to demonstrate that the investment in public health contributes to decreased morbidity and mortality. Based on the results, the investigators designed a new framework for measuring value and determining program priorities for public health agencies. Using the cost-accounting approach, the developed framework considers four component elements to determine program priorities: 1) external factors that must be taken into account; 2) key internal actions that an LHD must take; 3) the appropriate quantitative measures to assess value; and 4) ways to communicate value to politicians and to the public. Interviews from this study reflected that the moral imperative of public health efforts is no longer a compelling rationale for investments in public health services. Tangible evidence and measurable results are vital for funding decisions. It is thus necessary to provide policymakers and the public with a better understanding of the quantitative value of public health services. The proposed framework can help GPHS demonstrate measurable contributions to the population’s health. The framework can act as a guiding mechanism for developing better outcome measures and improved data collection and analysis. It can assist in developing general measures of the value of GPHS, creating guidelines for making tradeoffs at the margin between programs, and identifying ways to incorporate tangibles and intangibles. Overall, the new framework can facilitate communication between policymakers and practitioners, creating the potential for more informed and effective funding decisions in GPHS.