Making the Case for
Public Health
Featuring Glen Mays, PhD, MPH and
Renee Frauendienst, RN, PHN, BSN, CPI
June 26, 2014
Minnesota
Public Health
Research to
Action
Network
Learning Objectives
Learn about
emerging national
research
Explore implications
for Minnesota
Identify next steps
Kim Gearin
Minnesota Dept. of Health
Research to Action Network
Minnesota
Public Health
Research to
Action
Network
2
Key Research Questions
Do investments in local public health
activities and services contribute to changes
in population health and/or health care cost
savings?
Are returns greater in some communities?
Could Medicaid expansion have unintended
consequences for public health?
Minnesota
Public Health
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Research to Action Network
A partnership of LPHA, MDH,
SCHSAC, and UMN
Housed in the MDH Office of
Performance Improvement
Local steering committee members
Renee Frauendienst
Allie Freidrichs
Deb Jacobs
Lowell Johnson
Karen Jorgensen-Royce
Katherine Mackedanz
Rosemary Schultz
Minnesota
Public Health
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Practice-Based Research Networks
Minnesota
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Welcome!
Renee S. Frauendienst,
RN, PHN, BSN, CPI
Public Health Division Director
and CHS Administrator,
Stearns County Human Services
Founding member,
Research to Action Network
Steering Committee
Minnesota
Public Health
Research to
Action
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6
Welcome!
Glen P. Mays, MPH, PhD
Scutchfield Endowed Professor in Health
Services and Systems Research
Director, National Coordinating Center for
Public Health Services and Systems Research
Department of Health Management
and Policy, College of Public Health,
University of Kentucky
Minnesota
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Research Question
Do investments in local public health
activities and services contribute to
improvements in population health?
Minnesota
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Prior Research: Mortality Reductions Attributable to
Local Public Health Spending, 1993-2008
Minnesota
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Mays GP and Smith SA. Evidence links increases in public health spending to declines in preventable deaths.
Health Affairs 2011; 30(8): 1-9. http://content.healthaffairs.org/content/30/8/1585.full.html
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Research Question
How long does it take?
Do the benefits of LPH spending differ,
depending on local characteristics?
Community health needs and vulnerabilities?
The scope of local public health activities?
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How Long Does it Take? Cumulative
Effects of Public Health Spending
Minnesota
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Glen Mays. "Who Benefits from Public Health Spending and How Long Does it Take: Estimating Community-Specific
Spending Effects" 141st Annual American Public Health Association Annual Meeting. Boston, MA. Nov. 2013. Available at:
http://works.bepress.com/glen_mays/119
11
Community-Specific Estimates of Public Health
Spending on Heart Disease Mortality
Minnesota
Public Health
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Glen Mays. "Who Benefits from Public Health Spending and How Long Does it Take: Estimating Community-Specific
Spending Effects" 141st Annual American Public Health Association Annual Meeting. Boston, MA. Nov. 2013. Available at:
http://works.bepress.com/glen_mays/119
12
Community-Specific Estimates of Public Health
Spending on Heart Disease Mortality
Minnesota
Public Health
Research to
Action
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Glen Mays. "Who Benefits from Public Health Spending and How Long Does it Take: Estimating Community-Specific
Spending Effects" 141st Annual American Public Health Association Annual Meeting. Boston, MA. Nov. 2013. Available at:
http://works.bepress.com/glen_mays/119
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Conclusions
Sizable health and economic gains are
attributable to LPH expenditures
Gains are 21-44% larger in low income
communities
Gains are 17-38% larger for communities that
invest in a broad range of LPH activities
Cumulative effects over 10 years are nearly twice
as large as short term effects
No evidence of over-spending
Glen Mays. "Who Benefits from Public Health Spending and How Long Does it Take: Estimating Community-Specific
Spending Effects" 141st Annual American Public Health Association Annual Meeting. Boston, MA. Nov. 2013. Available at:
http://works.bepress.com/glen_mays/119
Minnesota
Public Health
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Questions, Comments?
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Research Questions
Do states respond to increases in Medicaid
spending by changing (reducing) spending
on other public health activities?
If so, what are the likely health and economic
benefits?
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Methods and Data
Retrospective analysis of all U.S. states during
1993-2011
Annual state government spending data linked
to LPH spending data from NACCHO Profile
Annual demographic, socioeconomic, and public
program enrollment data used as control
Econometric models estimate how state and
local public health spending change in response
to growth in Medicaid spending
Glen P. Mays. “Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA’s Health & Economic Effects.”
AcademyHealth Annual Research Meeting. San Diego, CA. Jun. 2014. Available at: http://works.bepress.com/glen_mays/161
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.01
Public Health Budget Share
.02
.03
.04
.05
.06
Medicaid and Public Health Spending
as a Share of Total State Spending
.1
.15
.2
.25
Medicaid Budget Share
FMAP>60
.3
.35
FMAP<=60
Glen P. Mays. “Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA’s Health & Economic Effects.”
AcademyHealth Annual Research Meeting. San Diego, CA. Jun. 2014. Available at: http://works.bepress.com/glen_mays/161
Minnesota
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Estimated Effect of 10% Medicaid Spending
Growth on Public Health Spending
State PH Spending
Local PH Spending
0
-0.2
% Decrease
-0.4
-0.6
-0.8
-1
-1.2
-1.4
-1.6
Glen P. Mays. “Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA’s Health & Economic Effects.”
AcademyHealth Annual Research Meeting. San Diego, CA. Jun. 2014. Available at: http://works.bepress.com/glen_mays/161
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10-Year Projected Effects of CrowdOut on Preventable Mortality Rates
14
12
% Increase
10
8
6
4
2
0
Infant
mortality
Cardiovascular
Diabetes
Cancer
Glen P. Mays. “Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA’s Health & Economic Effects.”
AcademyHealth Annual Research Meeting. San Diego, CA. Jun. 2014. Available at: http://works.bepress.com/glen_mays/161
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Conclusions
Medicaid spending growth results in
substantial “crowd-out” in public health
spending
Magnitude of crowd-out is sufficient to
produce sizeable health effects over time
Crowd-out may be larger for lower-resource
states and communities
Minnesota
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Glen P. Mays. “Does Medicaid Crowd Out Other Public Health Spending? Projecting ACA’s Health & Economic Effects.”
AcademyHealth Annual Research Meeting. San Diego, CA. Jun. 2014. Available at: http://works.bepress.com/glen_mays/161
21
Questions, Comments?
Minnesota
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Minnesota Context
Local Public Health Expenditures by Source of Funding, Minnesota, 2012
$120,000,000
$100,000,000
Local
Federal
State
$80,000,000
$60,000,000
$40,000,000
$20,000,000
$0
Infrastructure
Healthy
Communities
Infectious
Disease
Environmental
Disaster
Health Services
Health
Preparedness
Minnesota
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Inflation-Adjusted, Per Capita Expenditures of
Minnesota
Community Health Boards, 1979-2012
$80
$71.69
$70
Total LPH expenditures
$60
$55.98
$50
$53.07
Total local LPH expenditures
(local taxes and fees)
$40
$33.03
$30
$26.50
$26.36
$20.97
Local tax levy
$18.29
$20
$12.30
$10
$5.74
State LPH Act grant
$3.92
$7.25
Minnesota
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$0
1979
1984
1989
1994
1998
2003
2007
2010
2012
Edited Aug, 2014
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What Does this Mean for
Minnesota?
Initiatives underway or on the horizon
Policy at the local and/or state level
Health system reform
Future research direction
Minnesota
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Strategic Next Steps
How can we strategically use this information
in Minnesota?
Where do we go from here?
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Acknowledgements
Funded by the Robert Wood Johnson Foundation
through the National Coordinating Center for Public
health Services & Systems Research
Supported by the NIH National Center for Advancing
Translational Science through the Kentucky Center for
Clinical and Translational Science
Data provided by the University of Kentucky Center for
Poverty Research, supported by USDHHS/ASPE
Additional data provided by the National Association of
County and City Health Officials, National Profile of
Local Health Departments
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Acknowledgements
The Minnesota Department of Health is a
grantee of two national programs of the
Robert Wood Johnson Foundation
Public Health Services and Systems Research
Practice Based Research Network in Public Health
Minnesota
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For More Information
Renee Frauendienst
[email protected]
320-656-6284
Kim Gearin
[email protected]
651-201-3884
Minnesota Public Health Research to Action Network
www.health.state.mn.us/ran
Dr. Mays’ Research
Online: www.publichealthsystems.org
Journal: www.FrontiersinPHSSR.org
Archive: works.bepress.com/glen_mays
Blog: publichealtheconomics.org
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