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Comparative Study
. 2009 Oct;44(5 Pt 2):1796-817.
doi: 10.1111/j.1475-6773.2009.01014.x. Epub 2009 Aug 17.

Geographic variation in public health spending: correlates and consequences

Glen P Mays  1 , Sharla A Smith
Affiliations
Comparative Study

Geographic variation in public health spending: correlates and consequences

Glen P Mays et al. Health Serv Res. 2009 Oct.

Abstract

Objectives: To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.

Data sources and setting: Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.

Study design: A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.

Principal findings: The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.

Conclusions: The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

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Figures

Figure 1
Figure 1
Public Health Agency and Medicare Spending Levels in 2005, by Quintile of Public Health Spending
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