The Great Recession & Fiscal Allocation for Public

Transcript:The Great Recession & Fiscal Allocation for Public:
The Great Recession & Fiscal Allocation for Public Health: How Has Our Slice of The Pie Changed? Authors J. Mac McCullough, PhD, MPH Assistant Professor School for the Science of Health Care Delivery Arizona State University JP Leider, PhD Consultant, JP Leider Consulting LLC Gulzar Shah, PhD, MStat, MS Associate Dean for Research & Associate Professor Jiann-Ping Hsu College of Public Health Georgia Southern University Introduction & Motivation Local sources of revenues are important for LHD financial stability and may reflect local prioritization of public health relative to other programs Focus of most of the post recession studies have been to examine the changes in budgets regardless of sources of revenue A local health department’s local revenues are often evaluated relative to non-local revenues (e.g., % of revenues from local sources) A more informative comparison is an area’s local revenues for public health relative to other non-public health revenues “Fiscal allocation” for public health Total LHD Revenues Revenues from local sources Total Local Public Revenues 1 2 3 Research Question What is the local fiscal allocation for public health as of 2008? What organizational or jurisdictional factors are associated with higher fiscal allocation? How has fiscal allocation for public health changed since before the Great Recession? What organizational or jurisdictional factors are associated with higher levels of fiscal allocation retention? Especially important at the extremes (what separates the big gains from the big declines?) Methods Data sources: Local governmental revenue data from U.S. Census of Local Governments (2007 & 2012) Contains geographic and financial data on 87,000 local governments (cities, counties, school districts, special districts, etc.) LHD data from NACCHO Profile survey (2008 & 2013) Matched using FIPS codes, excluded LHDs with missing/unreliable expenditure data # LHDs in sample in both years: n = 983 LHDs Outcome of interest: Fiscal Allocation = (Total LHD Local Revenue) ÷ (Total Local taxes for corresponding local governments) Local revenue expenditure data self-reported to NACCHO by LHDs Local taxes include: property taxes, other collected taxes, fees, fines 2007, 2012, and change between 07-12 Univariate, bivariate, multivariate analyses Also compute models stratified by level of long-term debt Results Fiscal allocation varies widely across LHDs Large number of LHDs receive no fiscal allocation Small number of LHDs receive high fiscal allocation Substantial state-level variation Correlates of Fiscal Allocation in 2007 Variables not significant in model: Setting (urban, suburban, rural), % of population that is Non-White, LHD