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

Abstract

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.

Effects of the COVID-19 Pandemic on Operative Volume and Residency Training at Two Academic Neurosurgery Centers in New Orleans

“… 20 , 21 , 22 Secondary impacts stemming from increased health care expenditures may render this trend unsustainable without intervention. 3 , 4 , 5 , 6 , 7 Reports investigating potential inefficiencies in the logistics of patient care as it pertains to neurosurgery before the advent of the pandemic identified that patients discharged beyond perceived medical readiness resulted in a significant economic impact to the health care facility. 16 , 17 Such patients were found to be insured via a public plan and recipients of emergent interventions, hold multiple systemic medical comorbidities, and require prolonged ICU care and a discharge disposition to a specialized inpatient facility.…”

“…Spinal surgery represents an economic staple for neurosurgery, being reported as the disease condition with the highest rate of relative annual health expenditure. 3 , 4 Instrumented spinal fusions have a significant population of elective procedures and have been increasingly performed, with annual reimbursement steadily increasing before the emergence of COVID-19. 27 , 28 , 29 Speculatively, decreasing numbers of elective or nonemergent spinal procedures, secondary to both imposed restrictions as well as decreased likelihood of patients presenting or following up on an outpatient basis, provides a primary cause for reported decreases in weekly RVUs.…”

“… 1 , 2 The disease had spread to 214 countries 8 months after being declared a pandemic by the World Health Organization. 2 Before the emergence of COVID-19, the economic impact of health care spending had become a recent major point of discussion in the United States, 3 , 4 with national health expenditure percentage relative to gross domestic product (GDP) projected to increase from 17.7% in 2018 to 19.9% in 2028. 1 The pandemic has put further strain on an already unfavorable trend, with GDP decreasing globally as health expenditures increase, with hospitals becoming increasingly populated with critically ill, aged, and medically complex patients requiring emergent procedures and extended stays for multidisciplinary care despite disproportionate volume reductions in multiple medical subspecialties.…”

Public health nursing workforce and learning needs: A national sample survey analysis

“…In the decade prior to the COVID‐19 pandemic, government funding for public health and the PHN workforce in state and public health departments was consistently gutted over time (Orr et al., 2022; Yeager et al., 2022). According to the Association of State and Territorial Health Officials, there were approximately 10% decreases in federal and state funding to state health departments between 2010 and 2019 (Association of State and Territorial Health Officials, 2022a, 2022b).…”

“…In the decade prior to the COVID-19 pandemic, government funding for public health and the PHN workforce in state and public health departments was consistently gutted over time (Orr et al, 2022;Yeager et al, 2022)…”