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A Health Promoting Hospital: A Strategy in the Re-Design of the U.S. Health Care System
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Pennsylvania Medical Assistance: Connections within the Commonwealth\u27s Public Health System
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Financial Analysis and Structural Considerations to the Problem of Rural Public Health in Pennsylvania
Get PDFCurrently, none of Pennsylvania\u27s 48 rural counties has a local health department (LHD). This is despite the existance of laws that provide locales with per capita funding for public health and environmental services. This study examines the financial issues that may influence the establishment of a robust public health infrastructure in rural areas. The study looks at 10 rural counties in the state and, through financial analysis of different LHD models (using the 2003-04 financial data) for rural counties, helps demonstrate that the relatively high levels of local funds required to establish LHDs would be a major financial undertaking. Testing three models - single-county, bi-county and tri-county LHDs - the study shows that locales would require an average of $16 per capita annually in local funds. the model analysis shows that small population size, large geographic area, and the low availability of primary care servics drive expenses higher. Since rural counties have low population density, cover broad geographic expanses, and suffer from chronic lack of primary care services, rural LHDs covering rural counties have to cover a very large geographic area, a critical cost driver especially for environmental services such as water supply testing. Geographically large rural counties are also pressured to provide personal health services given the limited number of primary care providers. The result is a local health department with very high expenses. The paper concludes with policy considerations that may help to overcome these barriers, including establishing secondary formulas that are an alternative to per capita funding as well as creation start-up costs funds
Public Health Shortage Areas in Pennsylvania: A Barrier to Health Information
Get PDFOne of the essential functions of public health services is to “inform, educate, and empower people about health issues” (CDC 1994). Throughout the United States, the tendency is to have decentralized public health systems that leave the decision-making and a significant part of the financing to local county and municipal governments. This strong reliance on local government financing and control translates into extreme variations in per capita expenditures and access. This paper examines whether or not individuals residing in areas without a centralized public health infrastructure have more difficulty accessing health information to help them make informed decisions about healthy living and lifestyle choices. The paper compares the ease and accuracy of accessing basic public health information in counties and municipalities without a Local Health Department (LHD) as compared to counties and municipalities served by a LHD. The study examines the case of Pennsylvania, because the state has the lowest ratio of public health workers per person in the country (Gebbie 2000), and it has only 10 LHDs covering six counties and four municipalities. The study found that in areas without a LHD, residents had to make 20% more calls and received useful information in only 64% of the inquiries. This is compared with locales served by LHDs which required fewer calls in order to receive useful information, and in which useful information was attained 100% of the time. This assessment shows that the potential for callers to receive useful public health information in areas without a LHD was impacted by both the higher number of calls that were required and in the diversity of places to which callers were referred. In locales without LHDs, the caller was much more likely to be referred to a non-public health entity, and was statistically less likely to get to speak to a public health professional early on in their inquiry
Credentialing of the Public Health Work Force
Get PDFPennsylvania ranks last nationally among all states in the size of its public health workforce per capita. More than a doubling of the current workforce would be needed for Pennsylvania to achieve even the national average. For the foreseeable future Pennsylvania will depend even more heavily than other states on having a highly skilled public health workforce to overcome our shortages in numbers. In this paper, I will discuss the efforts to at long last develop a core credential for the public health workforce and the potential impact this will have on ensuring a highly competent public health work force capable of responding to the public health challenges facing our state and our nation. I will also consider the relationship between public health and medicine including comparing the approaches toward credentialing. Public health is virutally the only professional field without a credential. After many years of committees, task forces, and a recommendation from the Surgeon General, the National Board of Public Health Examiners (NBPHE) was incorporated in December 2005. Its volunteer board has seats allocated to a broad range of participating public health organizations. The first credentialing examination in August 2008, will test for knowledge of core and cross-cutting educational competencies that are relevant to the practice of public health. The driving forces leading to credentialing in public health include: 1) heightened recognition of the importance of the public health work force; 2) an increase in both the absolute number and percent of public health graduates who have no other credential; 3) increase in the availability of public health graduate education throughout the country; 4) societal demand for credentialing and for professional accountability; and 5) improved delineation of the core and cross-cutting educational competencies underlying public health practice