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CHAPTER 9 Public Health Finance Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Learning Objectives To describe how public health programs are financed To compare the allocation of health resources to medical care and public health To explain the role of federal federalism in funding To discuss variations in public health funding To identify most important public health financial management skills Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Overview Role of finance: plan for, acquire, and use resources to maximize efficiency and value of the organization Significant achievements can be credited to the public health however, like most public services, are provided within a constrained environment As the scarcity of financial resources increases, the role of public health finance increases in importance Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Sources Of Public Health Funds Programs are financed through a combination of federal, state, and local governmental appropriations and, especially at the local level, from local taxes, fees and other sources such as Medicaid and Medicare Financing public health at different levels is grounded in the theory of fiscal federalism Despite critical role public health, health resources of the U.S. are disproportionally allocated to the provision of medical care vs. promotion of health Federal spending accounts for about 13% of total public health expenditures, while state and local spending covers the remaining 87% Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Federal Funding Mechanisms (1 of 2) Federal funds are distributed through the agency system Each agency is responsible to manage distribution of funds utilized for public health services, including ensuring funds are used for the purposes stated in the enabling legislation and in a prudent manner Program funds are distributed to recipients through federal grants (awards), which use funds that are allocated from general revenues Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Federal Funding Mechanisms (2 of 2) Federal awards typically specify a time period, called the period of availability, during which the recipient may use the funds Most grants have a term of 1 year (although some may have a longer lifespan), and the recipient must use the grant funds within that time frame Expiration of funds is a consequence of the federal budget process Copyright © 2020 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Types of Federal Grants Categorical grants: Main source of federal aid to state and local governments for public health ...

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8Ethical Resource Allocation Cultura Limited/SuperStock Learning Objectives After reading this chapter, you should be able to 1. Understand the need to make ethically defensible rationing decisions in health care. 2. Analyze different methods of allocating health care resources. 3. Describe the steps decision makers must take to achieve moral authority through procedural justice. 4. Identify the ethical basis for setting utilization limits. 5. Understand the concept of medical futility. © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Introduction “How can a society or health plan meet population health care needs fairly under resource limitations?” (Daniels, 2008, p. vii). This compelling and controversial question gives rise both to health policy discussions and political debates. As enactment and implementation of the Affordable Care Act (ACA) has proceeded, public and political discourse has become heated whenever allocating scarce resources—negatively labeled health care rationing— is discussed. One common allegation early in the debates over the ACA was that it would severely impede Americans’ freedom of choice in health care by empowering expert panels (rather than treating clinicians) to make decisions about the care individuals could receive. A prominent political candidate went so far as to suggest that “death panels” would be set up by the government to determine “whether [the elderly and disabled] are worthy of healthcare” (Viebek, 2012, para. 9), a sentiment that severely influenced the public’s view of the ACA. Much has changed since these early debates, including the repeal of the ACA’s Independent Payment Advisory Board—the aforementioned “panel of experts”—as well as Americans’ public opinion of the law (see Figure 8.1). Figure 8.1: The public’s view on the ACA “Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?” This was the question asked during an April 2018 health tracking poll collected by the Kaiser Family Foundation. Although the law has been a divisive issue since its enactment, its approval rating has increased since January 2017. Source: The Kaiser Family Foundation. (2018). The public’s views on the ACA. Licensed under CC BY-NC-ND 4.0. Retrieved from https://www.kff.org/interactive/kaiser-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable --Unfavorable--Don’t%2520Know&total The United States’ health system under the ACA does, in fact, ration health care. However, this phenomenon is not new or the result of a political agenda. Health care rationing, or the allocation of scarce resources, is an inevitable feature of modern health care systems all over the world. Whenever the need or demand for any product or service outstrips its availability or supply, some form of rationing will occur. In recent decades, the most common rationing © 2019 Brid.

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