What drives variations in public health and social services expenditures? the association between political fragmentation and local expenditure patterns

Objectives. To examine spending and resource allocation decision-making to address health and social service integration challenges within and between governments. Methods. We performed a mixed methods case study to examine the integration of health and social services in a large US metropolitan area, including a city and a county government. Analyses incorporated annual budget data from the city and the county from 2009 to 2018 and semistructured interviews with 41 key leaders, including directors, deputies, or finance officers from all health care–, health-, or social service–oriented city and county agencies; lead budget and finance managers; and city and county executive offices. Results. Participants viewed public health and social services as qualitatively important, although together these constituted only $157 or $1250 total per capita spending in 2018, and per capita public health spending has declined since 2009. Funding streams can be siloed and budget approaches can facilitate or impede service integration. Conclusions. Health and social services should be integrated through greater attention to the budgetary, jurisdictional, and programmatic realities of health and social service agencies and to the budget models used for driving the systems-level pursuit of population health.

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Evaluation designs of outpatient health centres focusing on vulnerable patient groups

European Journal of Public Health ◽

10.1093/eurpub/ckz186.343 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Winkler ◽

I Reinsperger

Keyword(s):

Public Health ◽

Mental Health ◽

Health Status ◽

Social Services ◽

Complex Interventions ◽

Health And Social Services ◽

Vulnerable Patient ◽

Patient Groups ◽

Health Institutions ◽

The Impact

Abstract Background Homeless and non-insured persons experience worse physical and mental health than comparable populations. Outpatient (public) health institutions, which are easily accessible, contribute considerably to the medical treatment of vulnerable patient groups. Sound evaluation methods, indicators and instruments are necessitated to target patients’ needs and to enable strategic health and social policy planning. Methods We conducted a systematic literature search in several databases (PubMed, EMBASE, PsycINFO etc.) for studies from 2000 to 2019 reporting on evaluations in outpatient health institutions for homeless and/ or non-insured patients. In addition, we contacted 5 Austrian public health/ research institutions dealing with complex interventions for relevant publications. Results 12 evaluation studies and 7 evaluation reports met our inclusion criteria. Evaluation designs mostly considered various target groups and nearly all assessments pursued a ’mixed-method’ approach. 13 publications assessed socio-demographic data, 11 the use of health and social services and 7 patients’ health status. Further indicators related to ’satisfaction issues’ such as patients’ satisfaction with the provided range of health and social services (n = 7). 6 publications reported on health economic indicators. In total, 7 out of 19 studies reported on evaluation instruments; most instruments (n = 6) were on patients’ mental health status. Conclusions Patients represented the major target group in the included evaluations. There is little research on evaluation indicators directing on health professionals. Evaluations focusing on the intersectional levels (e.g. the impact of health programmes for vulnerable groups on various institutions) are lacking. Key messages Evaluation designs involving ‘hardly to reach populations’ shall consider a ‘participatory assessment approach’ to avoid drop-outs and to create a trustworthy evaluation situation. Hence, evaluation indicators shall be commonly selected and adequately reflect patients’ realities.

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Fostering Partnerships Between Public Health Functions Within Health And Social Services Organizations: A Perspective From The Province Of Quebec (Canada)

Journal of Preventive Medicine And Care ◽

10.14302/issn.2474-3585.jpmc-16-1106 ◽

2016 ◽

Vol 1 (2) ◽

pp. 22-26 ◽

Cited By ~ 1

Author(s):

Mélissa Généreux ◽

Linda Pinsonneault ◽

Mathieu Roy

Keyword(s):

Public Health ◽

Social Services ◽

Health And Social Services ◽

Public Health Functions

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Public Health and Social Services

Occupational and Environmental Medicine ◽

10.1136/oem.23.3.247 ◽

1966 ◽

Vol 23 (3) ◽

pp. 247-247

Author(s):

R. A. N. Hitchens

Keyword(s):

Public Health ◽

Social Services ◽

Health And Social Services

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Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019856977 ◽

2019 ◽

Vol 56 ◽

pp. 004695801985697

Author(s):

J. Mac McCullough

Keyword(s):

Public Health ◽

Health Outcomes ◽

Social Services ◽

Government Spending ◽

Service Provision ◽

Scale Up ◽

Public Hospitals ◽

County Level ◽

Health And Social Services ◽

Health Social Services

Population health improvements can be achieved through work made possible by government spending on health care, public health, and social services. The extent to which spending allocations across these sectors is synergistic with or trade-off against one another is unknown. Achieving a balanced portfolio with multi-sector contributions is key to improving health outcomes. This study tested competing hypotheses regarding achievement of balanced multi-sector resources for health. County-level U.S. Census Bureau data on all local governmental spending measured each county’s average per capita local government spending for public hospitals, public health, social services, and education. American Hospital Association (AHA) Annual Survey data on hospital community health service provision were used to calculate an index of hospital community service provision aggregated to county level by year. County Health Rankings data measured each county’s health outcomes and health factors. Longitudinal mixed-effects regression models (n = 1877 counties) predicted changes in spending for each government spending category based on two sets of predictors ( government spending vs community health services and needs) from current and prior year. Models account for average spending in each category and county-, state-, and time-trends. Models showed that spending increases in each of the four spending categories examined (public hospitals, public health, social services, and education) were not associated with changes in spending across other categories in current or prior years. For all categories, an increase from baseline spending levels in Year 1 was always significantly associated with an increase from baseline spending level in that same category in Year 2 (ie, spending stayed above baseline in Year 2). Multi-sector initiatives to health outcomes require funding across sectors, yet there was little evidence to suggest that communities that invest in public hospitals, public health, or other social services see commensurate increases in other areas. Underlying funding decisions may reflect strategic decisions within a community to scale up single sectors, constrained resources for multi-sector scale up, or a host of additional factors not measured here.

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PUBLIC HEALTH AND SOCIAL SERVICES SYSTEM: THE DISENCHANTMENT OF ISOLATED SENIOR CAREGIVERS

Innovation in Aging ◽

10.1093/geroni/igz038.1420 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S387-S387

Author(s):

Melanie Couture ◽

Pam Orzeck ◽

Apostolia Petropoulos

Keyword(s):

Public Health ◽

Social Services ◽

Social Isolation ◽

Local Community ◽

Formal System ◽

Negative Consequences ◽

Care Providers ◽

Health And Social Services ◽

The Social ◽

Formal Services

Abstract Social isolation is one of the negative consequences associated with caregiving and is experienced by approximately 20% of Canadian family caregivers. Being in a public health and social services system, Canadian caregivers should normally turn to their local community service centres (CLSC) to access formal services and feel less isolated. However, studies have shown that satisfaction is low regarding accessibility and continuity of formal support services. In an effort to develop interventions that meet the needs of isolated senior caregivers, the purpose of this exploratory descriptive qualitative study was to identify challenges encountered in accessing and utilizing formal supports within the public health and social services system in Canada. Nineteen isolated senior caregivers participated in seven focus groups. Data analysis was performed using the Miles, Huberman, and Saldana (2014) approach. Results showed that isolated caregivers do not know where to get information about existing services within the formal system. Once services are found, waiting lists are linked to unbearable delays. Some caregivers are actually redirected to private services, if they can afford it. Isolated caregivers also criticize the unpredictability of the system as they face relentless changes of care providers, inadequate services and sometimes unwarranted cancellations or terminations. In addition, they find formal services lacking human sensitivity. Many of them come to the conclusion that formal services are not worthwhile and exclude themselves from the formal system. This research demonstrated that the health and social services system can actually contribute to the social isolation of senior caregivers longing for support.

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