The Importance of Governmental and Nongovernmental Investments in Public Health and Social Services for Improving Community Health Outcomes

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

Art therapy in Alzheimer's disease. An opportunity of collaboration between intersectoral public and private organizations in the co-design of health and social care services

Introduction

The World Health Organization (WHO) has recognized art therapy as an effective supportive mechanism for the maintenance and restoration of mental health. In recent years, art therapy has been integrated in the assistance pathways of older people affected by neurocognitive disorders according to the demonstrated benefits, as no conflicts with pharmacologic treatments and the reduction of anxiety and stress. The shortage of organizational, economic, and professional resources in social-health public organizations does not allow for guaranteeing the provision of these services without the help of the private ones, not exclusively belonging to social-health sector. This research aims to investigate how the collaboration between public and private organizations of different sectors in the co-provision of non-pharmacological approaches guarantees the economic sustainability and the quality improvement of the provided services.

Methods

The Alzheimer Café of Prato was selected as a significant case study.

Results and Discussion

Art therapy programs intended for taking care of older people in the first stages of the Alzheimer's disease have been developed, planned, supplied, and managed over the years as a result of the integration of resources, ideas, and professionals provided both by public and private sectors, the social-health sector, and cultural organizations.

Conclusions

The peer-to-peer co-responsibility of all organizations (public and private, from the cultural sector as well as the social and health sector) involved in the co-design of art therapy programs, not limiting their actions to only co-financing and/or co-delivery of the service, enabled the achievement of the economic sustainability of the services and the improvement of their quality.

Has smart city transition elevated the provision of healthcare services? Evidence from China's Smart City Pilot Policy

This paper endeavors to identify the causal effects between the smart city transition and the provision of healthcare services while uncovering potential pathways of influence. This study first constructs a logical analytical framework and posits five hypotheses for examination. Subsequently, leveraging the quasi-natural experiment of the China Smart City Pilot Policy (CSCPP), empirical tests are conducted utilizing a Difference-in-Differences (DD) two-way fixed effects model. The findings suggest that the CSCPP has significantly enhanced the provision of healthcare services. Even after addressing the formidable challenges of endogeneity, sample self-selection, and spatial spillovers, the conclusion remains robust. Mechanism tests indicate that the CSCPP primarily operates through two avenues: augmenting human resources and institutional services. Heterogeneity tests reveal that the efficacy of CSCPP is heightened in cities boasting administrative approval service centers, experiencing diminished financial constraints, and exhibiting elevated healthcare provision levels and situated in the eastern region. The theoretical and empirical analysis of this paper demonstrates that smart city transitions can facilitate the enhancement of healthcare services. The potential contribution of this paper is to enrich the conceptualization of governance frameworks for smart city transition while providing empirical evidence from China.

Challenges faced by community connectors: lessons learned from a Taiwan public health initiative

Background

Effective solutions that meet the diverse community health needs of older adult populations are of critical importance. To address these needs, a nationwide community connector team—tasked with providing referral support to older adult populations and completing an asset mapping resource inventory initiative centered around the needs of older adult populations—was developed in Taiwan. The purpose of this qualitative study was to explore community connectors’ experiences and challenges.

Methods

Community connectors (n = 26) across four diverse sites participated in focus group interviews in July 2020. Interviews explored the challenges community connectors encountered in their roles; the strategies used to address these challenges; the asset mapping process; and on how they conceptualized their roles. Qualitative content analysis was applied.

Results

Three themes were uncovered: developing community ties, cross-organization interactions and professional conflicts. The findings show that community connectors face hurdles in uncovering community resources and that they experience considerable professional instability. The findings also shed light on the day-to-day approaches used to navigate on-the-job challenges and the steps taken to develop community partnerships.

Conclusions

The experiences of community connectors provide important insights and can serve to illuminate the development of similar initiatives that seek to use community connectors for community health related purposes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03565-8.

Exploring the Relationship Between Local Governmental Spending on the Social Determinants of Health and Health Care Costs of Privately Insured Adults

Greater investment in the social determinants of health (SDOH) is positively associated with improved health outcomes of both individuals and their communities, which in turn may help to bend the health care cost curve and reduce health care spending. The purpose of this study was to examine the relationship between local governments' spending on the SDOH and the health care costs of privately insured nonelderly adults. Annual spending by local governments on the SDOH for the years 2007-2017 was obtained from the Census of Governments. Annual health care costs for privately insured nonelderly adults for the years 2013-2017 was obtained from the Health Care Cost Institute. Bivariate and multivariate regression analyses were performed to examine the association between county-level local governments' per capita spending on the SDOH and the per member health care costs of privately insured adults living in these counties controlling for community characteristics. All analyses were conducted in 2021. For near-elderly adults ages 55-64, health care costs were significantly higher in counties with the lowest levels of local governmental spending on the SDOH. For adults ages 18-54, in contrast, health care costs were unrelated to local governmental spending. Investments of local governments in the SDOH may have rather limited potential to yield meaningful savings in health care costs for privately insured nonelderly adults at the population level, especially once such investments exceed a minimum threshold.

Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report

CONTEXT

Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure.

OBJECTIVES

This review examines the influence of the Finance report's 10 recommendations on public health policy and practice.

DESIGN

This review utilized peer-reviewed and gray literature published since 2012.

ELIGIBILITY CRITERIA

Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community.

RESULTS

Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts.

DISCUSSION

Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending.

CONCLUSIONS

The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

Local Health and Social Services Spending to Reduce Preventable Hospitalizations

Upstream spending on social determinants of health can lead to improved downstream population health outcomes but intermediate steps between these end points are unclear. The purpose of this study was to determine the longitudinal impacts of government spending on hospital visits for potentially preventable conditions. The authors used secondary data sets from 2007-2014 to measure county-level Prevention Quality Indicator (PQI) rates, local government health and social services spending, hospital-provided community health services, and other sociodemographics. Mixed effects models regressed county PQI rates on deviation from mean local government spending from 4 years previously to account for lag between spending and outcomes. Thirty-two states reported PQI data; complete data were available for 1660 counties. Controlling for baseline spending levels, a 1-time $10 per capita increase in social services spending was associated with 1.9 fewer preventable hospitalizations (per 100,000) within 4 years (P < 0.001); $10 increases in public health or education were associated with 1.8 and 2.2 fewer preventable hospitalizations (per 100,000), respectively (P < 0.001). The association between change in spending and change in PQI was larger for acute than for chronic conditions. Additional health and social services spending by local governments can prevent hospitalizations for conditions for which quality outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or progression of disease. Upstream spending can affect health care utilization and may offer a way to improve health outcomes or reshape the health care cost curve.

Integrating local health departments to reduce suicide-related emergency department visits among people with substance use disorders - Evidence from the state of Maryland

Individuals with a substance use disorder (SUD) are six times as likely than those without a SUD to attempt suicide, however just 18% of the SUD population has received treatment. One of the barriers to treatment is appropriate and timely mental health services. This resulted in a substantial increase in emergency department (ED) visits related to SUD and suicide. This study sought to determine if the number of suicide-related ED visits for patients with SUD is associated with the types of mental health activities provided by their local health department (LHD). Specifically, we examined whether patients with a SUD aged 18-64 experienced reductions in suicide-related ED visits when their LHD directly engaged in mental health activities, such as (1) primary prevention for mental illness or (2) mental health services. Using linked datasets for 2012 from the National Profile of Local Health Departments, U.S. Census data, Area Health Resource File, and Maryland's State Emergency Department Databases (SEDD), we employed multivariable logistic regressions and instrumental variable models to examine this association. After adjusting for the endogeneity of LHDs' activity measures and controlling for individual-, hospital-, LHD-, and county-level characteristics, results demonstrated patients with a SUD experienced a 6% and 5% reduction in suicide-related ED visits when their LHD directly provided primary prevention for mental illness and mental health services, respectively. The results are small but significant, with robust standard errors. This study suggests LHDs may be key players in preventing suicide-related ED visits among the SUD population.