The influence of organizational and county characteristics on local ...
The influence of organizational and county characteristics on local health department revenue Susan Zahner1, DrPH, RN; Senay Goitom2, BA; Andrew Reschovsky3, PhD 1. Associate Professor, School of Nursing, UW-Madison; 2. Project Assistant-Graduate Student, Robert LaFollette School of Public Affairs, UW-Madison; 3. Professor, Robert LaFollette School of Public Affairs, UW-Madison
Background
Results
Discussion
• Local health department (LHD) funding comes from a variety of sources including local government, grants (federal, state, and private), fees for services, and charitable donations. • Economic recession is associated with declines in local government revenues and often state aid. • One strategy for addressing revenue decline from local government sources is to increase revenue from other sources. • Wide variation between LHDs in level and types of revenue from non-local government sources exists but is not well understood. • Research on patterns and influences on public health financing is lacking.
Research Questions Revenue Sources
• What LHD organizational characteristics are associated with higher levels of revenues from sources other than local government overall and by type of revenue source? • What county/jurisdictional characteristics are associated with higher levels of revenues from sources other than local government overall and by type of revenue source? • Has LHD revenue from sources other than local government, overall and by type of revenue, changed over time (2004-2008)?
population
poverty rate
Methods • Calculated per capita, inflation-adjusted, total non-local-tax revenue and total expenditure for LHD i for years 2002-2008 • Calculated per capita, inflation-adjusted revenue for LHD i for each of the following non-local government revenue sources: federal revenue; state revenue; fee for service; donations; private grants • Separately regressed each of these revenue sources on a vector of jurisdiction-wide characteristics, a vector of LHD characteristics, and a vector of time trend variables:
=
+
+
County/ Jurisdictional Characteristics
Observations
Mean
Minimum
Maximum
Private Grants
All Non Local Tax Revenue
0.0207***
-0.000718
(0.00244)
(0.00156)
-0.00472*
-0.000109
0.00154***
0.0174***
(0.00270)
(0.000533)
(0.000521)
(0.00519)
-0.139
0.247
0.00484
-0.0661**
-0.221
(0.158)
(0.0314)
(0.0306)
(0.304)
median income
-0.333***
0.0188
0.148*
-0.0207
-0.0411**
-0.193
(0.0749)
(0.0480)
(0.0829)
(0.0164)
(0.0160)
(0.159)
percent non-white
0.0741**
0.0323
-0.100**
-0.00357
0.00839
-0.00974
(0.0361)
(0.0231)
(0.0400)
(0.00789)
(0.00771)
(0.0768)
0.415*
-0.192
0.133
-0.00554
0.0211
0.454
(0.223)
(0.143)
(0.247)
(0.0491)
(0.0479)
(0.474)
0.108
0.202***
0.188
0.0173
-0.0134
0.514**
(0.111)
(0.0707)
(0.123)
(0.0243)
(0.0237)
(0.235)
percent male
county health ranking
voter turnout
Standard Deviation
Donations
(0.0914)
independent LHD
Variable
Fee for Services
(0.143)
equalized property value
Results
State Revenue
-0.364**
percent 65+ years old
+
Federal Revenue
0.0257
0.0293
-0.0659
0.000367
-0.00167
-0.00618
(0.0388)
(0.0247)
(0.0429)
(0.00895)
(0.00827)
(0.0824)
0.0170
0.235
1.267***
0.0761
0.0782
1.788**
(0.369)
(0.236)
(0.409)
(0.0807)
(0.0791)
(0.785)
0.0224
-0.0911**
0.0828
0.0417***
0.0282**
0.0718
(0.0665)
(0.0424)
(0.0736)
(0.0147)
(0.0142)
(0.141)
0.474
0.110
2.362***
-0.263***
0.171**
2.902***
(0.389)
(0.248)
(0.431)
(0.0855)
(0.0840)
(0.827)
ch140 Level 2
1.857**
0.357
0.152
0.173
0.150
2.744*
(0.731)
(0.466)
(0.808)
(0.159)
(0.156)
(1.552)
ch140 Level 3
1.885**
1.050**
2.660***
0.115
0.291*
5.755***
(0.751)
(0.479)
(0.830)
(0.163)
(0.160)
(1.594)
-0.0481
1.367**
4.379***
-0.213
0.565***
6.816***
(0.872)
(0.557)
(0.964)
(0.190)
(0.186)
(1.851)
-1.212
0.945**
1.544*
0.0313
-0.0969
1.464
(0.752)
(0.479)
(0.832)
(0.165)
(0.161)
(1.597)
-1.408*
0.328
1.653**
-0.0635
-0.156
0.546
(0.723)
(0.462)
(0.799)
(0.158)
(0.155)
(1.535)
1.726**
1.725***
3.533***
0.355**
0.220
7.674***
(0.745)
(0.476)
(0.824)
(0.163)
(0.159)
(1.582)
0
0
0
0
0
0
(0)
(0)
(0)
(0)
(0)
(0)
County/jurisdictional characteristics associated with higher per capita non-local government revenues included: • Larger population (Overall, federal, fees, & private grants) • Lower poverty rates (Federal & private grants) • Median income (Fees) • Better county health ranking (Overall & fees) • Voter turnout (Donations & private grants) County/jurisdictional characteristics associated with lower non-local government revenues included: • Median income (Federal & private grants) • Voter turnout (State grants) LHD characteristics associated with higher non-local government revenues included: • Independent health department compared to human service model (Overall, fees, & private grants) • More complex service mix/higher certification level (Overall, federal state, fees, & private grants) • Region of state (compared to SE) • North (overall, state grants, fees, & private grants) • South (state grants & fees) • Northeast (fees) • West (overall, federal, state, fees, and donations) LHD characteristics associated with lower non-local government revenues included: • Independent health department compared to human service model (Donations) • Region of state (compared to SE) • Northeast (federal grants) Time trend: Compared to 2004, 2006-2008 indicated more federal grant revenue (likely related to H1N1 response and an increase in WIC funding) and more private grant revenues. Overall per capita non-local government revenue did not change significantly over this time period.
Limitations • Aggregate county-level measures may mask important variations among sub-county (city/town) LHD jurisdictions • Analysis is descriptive only and limited to 5 years of data (2004-2008)
Conclusions
Dependent Variables Federal Revenue
652
5.64
4.38
0
45.82
State Revenue
651
2.10
2.53
0.00
18.72
Fee for Services
653
5.12
5.38
0.00
74.91
Donations
645
0.14
0.86
0.00
14.49
Private Grants
645
0.29
0.72
0.00
8.99
Total Non-Local-Tax Revenue
653
13.38
9.43
0.00
90.78
4.59
595.958
northern region Local Health Department Characteristics southern region
northeastern region
Jurisdiction/County Characteristics western region
population (in 1000s)
653
59.61
80.57
poverty rate
686
10.87
4.10
3.40
34.10
median income (in $1,000s)
686
45.25
7.72
28.01
75.94
percent non-white
686
9.75
12.60
0.95
85.71
percent male
686
49.80
1.05
48.05
53.91
percent 65+ years old
686
14.48
3.29
9.16
25.59
equalized property value (in $10,000s)
641
8.85
4.93
3.55
70.23
county health ranking
490
0.127
0.857
-1.730
3.000
voter turnout
686
62.35
4.49
49.33
77.00
Local Health Department Characteristics local health department type
686
0.76
0.43
0
1
Level 2
686
0.531
0.499
0
1
Level3
686
0.357
0.480
0
1
Northern Region
686
0.153
0.360
0
1
Southern Region
686
0.224
0.418
0
1
Northeastern Region
686
0.204
0.403
0
1
Southeastern Region
686
0.235
0.424
0
1
Western Region
686
0.184
0.388
0
1
2004b.year
2005.year
2006.year Time Trend
-0.318
-0.0196
0.492
-0.0300
0.0211
0.734
(0.515)
(0.328)
(0.568)
(0.113)
(0.111)
(1.091)
1.029*
-0.424
0.272
-0.0279
0.249**
0.972
(0.531)
(0.339)
(0.588)
(0.116)
(0.114)
(1.128)
2007.year
1.097*
-0.288
0.0242
0.0367
0.441***
1.168
(0.581)
(0.371)
(0.643)
(0.127)
(0.124)
(1.235)
2008.year
1.389**
-0.398
-0.294
0.0734
0.347**
0.873
(0.641)
(0.409)
(0.709)
(0.140)
(0.137)
(1.361)
-2.850
13.27
-22.38
-1.483
-0.419
-20.18
(13.24)
(8.442)
(14.65)
(2.925)
(2.836)
(28.12)
Chapter 140 (Base level=1)
Constant
Observations R-squared
453
453
454
448
449
454
0.331
0.201
0.311
0.122
0.214
0.364
Standard errors in parentheses
*** p
Background
Results
Discussion
• Local health department (LHD) funding comes from a variety of sources including local government, grants (federal, state, and private), fees for services, and charitable donations. • Economic recession is associated with declines in local government revenues and often state aid. • One strategy for addressing revenue decline from local government sources is to increase revenue from other sources. • Wide variation between LHDs in level and types of revenue from non-local government sources exists but is not well understood. • Research on patterns and influences on public health financing is lacking.
Research Questions Revenue Sources
• What LHD organizational characteristics are associated with higher levels of revenues from sources other than local government overall and by type of revenue source? • What county/jurisdictional characteristics are associated with higher levels of revenues from sources other than local government overall and by type of revenue source? • Has LHD revenue from sources other than local government, overall and by type of revenue, changed over time (2004-2008)?
population
poverty rate
Methods • Calculated per capita, inflation-adjusted, total non-local-tax revenue and total expenditure for LHD i for years 2002-2008 • Calculated per capita, inflation-adjusted revenue for LHD i for each of the following non-local government revenue sources: federal revenue; state revenue; fee for service; donations; private grants • Separately regressed each of these revenue sources on a vector of jurisdiction-wide characteristics, a vector of LHD characteristics, and a vector of time trend variables:
=
+
+
County/ Jurisdictional Characteristics
Observations
Mean
Minimum
Maximum
Private Grants
All Non Local Tax Revenue
0.0207***
-0.000718
(0.00244)
(0.00156)
-0.00472*
-0.000109
0.00154***
0.0174***
(0.00270)
(0.000533)
(0.000521)
(0.00519)
-0.139
0.247
0.00484
-0.0661**
-0.221
(0.158)
(0.0314)
(0.0306)
(0.304)
median income
-0.333***
0.0188
0.148*
-0.0207
-0.0411**
-0.193
(0.0749)
(0.0480)
(0.0829)
(0.0164)
(0.0160)
(0.159)
percent non-white
0.0741**
0.0323
-0.100**
-0.00357
0.00839
-0.00974
(0.0361)
(0.0231)
(0.0400)
(0.00789)
(0.00771)
(0.0768)
0.415*
-0.192
0.133
-0.00554
0.0211
0.454
(0.223)
(0.143)
(0.247)
(0.0491)
(0.0479)
(0.474)
0.108
0.202***
0.188
0.0173
-0.0134
0.514**
(0.111)
(0.0707)
(0.123)
(0.0243)
(0.0237)
(0.235)
percent male
county health ranking
voter turnout
Standard Deviation
Donations
(0.0914)
independent LHD
Variable
Fee for Services
(0.143)
equalized property value
Results
State Revenue
-0.364**
percent 65+ years old
+
Federal Revenue
0.0257
0.0293
-0.0659
0.000367
-0.00167
-0.00618
(0.0388)
(0.0247)
(0.0429)
(0.00895)
(0.00827)
(0.0824)
0.0170
0.235
1.267***
0.0761
0.0782
1.788**
(0.369)
(0.236)
(0.409)
(0.0807)
(0.0791)
(0.785)
0.0224
-0.0911**
0.0828
0.0417***
0.0282**
0.0718
(0.0665)
(0.0424)
(0.0736)
(0.0147)
(0.0142)
(0.141)
0.474
0.110
2.362***
-0.263***
0.171**
2.902***
(0.389)
(0.248)
(0.431)
(0.0855)
(0.0840)
(0.827)
ch140 Level 2
1.857**
0.357
0.152
0.173
0.150
2.744*
(0.731)
(0.466)
(0.808)
(0.159)
(0.156)
(1.552)
ch140 Level 3
1.885**
1.050**
2.660***
0.115
0.291*
5.755***
(0.751)
(0.479)
(0.830)
(0.163)
(0.160)
(1.594)
-0.0481
1.367**
4.379***
-0.213
0.565***
6.816***
(0.872)
(0.557)
(0.964)
(0.190)
(0.186)
(1.851)
-1.212
0.945**
1.544*
0.0313
-0.0969
1.464
(0.752)
(0.479)
(0.832)
(0.165)
(0.161)
(1.597)
-1.408*
0.328
1.653**
-0.0635
-0.156
0.546
(0.723)
(0.462)
(0.799)
(0.158)
(0.155)
(1.535)
1.726**
1.725***
3.533***
0.355**
0.220
7.674***
(0.745)
(0.476)
(0.824)
(0.163)
(0.159)
(1.582)
0
0
0
0
0
0
(0)
(0)
(0)
(0)
(0)
(0)
County/jurisdictional characteristics associated with higher per capita non-local government revenues included: • Larger population (Overall, federal, fees, & private grants) • Lower poverty rates (Federal & private grants) • Median income (Fees) • Better county health ranking (Overall & fees) • Voter turnout (Donations & private grants) County/jurisdictional characteristics associated with lower non-local government revenues included: • Median income (Federal & private grants) • Voter turnout (State grants) LHD characteristics associated with higher non-local government revenues included: • Independent health department compared to human service model (Overall, fees, & private grants) • More complex service mix/higher certification level (Overall, federal state, fees, & private grants) • Region of state (compared to SE) • North (overall, state grants, fees, & private grants) • South (state grants & fees) • Northeast (fees) • West (overall, federal, state, fees, and donations) LHD characteristics associated with lower non-local government revenues included: • Independent health department compared to human service model (Donations) • Region of state (compared to SE) • Northeast (federal grants) Time trend: Compared to 2004, 2006-2008 indicated more federal grant revenue (likely related to H1N1 response and an increase in WIC funding) and more private grant revenues. Overall per capita non-local government revenue did not change significantly over this time period.
Limitations • Aggregate county-level measures may mask important variations among sub-county (city/town) LHD jurisdictions • Analysis is descriptive only and limited to 5 years of data (2004-2008)
Conclusions
Dependent Variables Federal Revenue
652
5.64
4.38
0
45.82
State Revenue
651
2.10
2.53
0.00
18.72
Fee for Services
653
5.12
5.38
0.00
74.91
Donations
645
0.14
0.86
0.00
14.49
Private Grants
645
0.29
0.72
0.00
8.99
Total Non-Local-Tax Revenue
653
13.38
9.43
0.00
90.78
4.59
595.958
northern region Local Health Department Characteristics southern region
northeastern region
Jurisdiction/County Characteristics western region
population (in 1000s)
653
59.61
80.57
poverty rate
686
10.87
4.10
3.40
34.10
median income (in $1,000s)
686
45.25
7.72
28.01
75.94
percent non-white
686
9.75
12.60
0.95
85.71
percent male
686
49.80
1.05
48.05
53.91
percent 65+ years old
686
14.48
3.29
9.16
25.59
equalized property value (in $10,000s)
641
8.85
4.93
3.55
70.23
county health ranking
490
0.127
0.857
-1.730
3.000
voter turnout
686
62.35
4.49
49.33
77.00
Local Health Department Characteristics local health department type
686
0.76
0.43
0
1
Level 2
686
0.531
0.499
0
1
Level3
686
0.357
0.480
0
1
Northern Region
686
0.153
0.360
0
1
Southern Region
686
0.224
0.418
0
1
Northeastern Region
686
0.204
0.403
0
1
Southeastern Region
686
0.235
0.424
0
1
Western Region
686
0.184
0.388
0
1
2004b.year
2005.year
2006.year Time Trend
-0.318
-0.0196
0.492
-0.0300
0.0211
0.734
(0.515)
(0.328)
(0.568)
(0.113)
(0.111)
(1.091)
1.029*
-0.424
0.272
-0.0279
0.249**
0.972
(0.531)
(0.339)
(0.588)
(0.116)
(0.114)
(1.128)
2007.year
1.097*
-0.288
0.0242
0.0367
0.441***
1.168
(0.581)
(0.371)
(0.643)
(0.127)
(0.124)
(1.235)
2008.year
1.389**
-0.398
-0.294
0.0734
0.347**
0.873
(0.641)
(0.409)
(0.709)
(0.140)
(0.137)
(1.361)
-2.850
13.27
-22.38
-1.483
-0.419
-20.18
(13.24)
(8.442)
(14.65)
(2.925)
(2.836)
(28.12)
Chapter 140 (Base level=1)
Constant
Observations R-squared
453
453
454
448
449
454
0.331
0.201
0.311
0.122
0.214
0.364
Standard errors in parentheses
*** p
