We have to construct on the teachings realized from the event and implementation of a single plan of account to advertise a post-pandemic public well being financing infrastructure that can help a resilient and accountable future for public well being.
The US public well being system has very restricted means to constantly account for the assets that circulate from its varied funding sources to state and native well being departments. Whereas we all know these assets have lengthy been grossly insufficient, we have additionally had a horrible time quantifying how a lot we actually want and for what functions. And we’ll now have issue describing how new funds, because the COVID-19 pandemic, are getting used. A lot of this thriller exists as a result of state and native public well being companies haven’t any widespread, standardized method to accounting for his or her particular revenues and expenditures. But different areas of presidency and business have for many years had established mechanisms for widespread reporting of standardized metrics round expenditures, revenues, personnel, and providers.
In our not too long ago revealed article entitled A Uniform Chart of Accounts: Strengthening Public Well being Apply and Analysis By Standardized Monetary Information, we describe the event of a Uniform Chart of Accounts (UCOA) for public well being, together with its implementation and operationalization in public well being planning, policymaking, and advocacy . We additionally argue for the institutionalization of such a UCOA in state and native public well being practices. With out broad help for and use of UCOA as a standard technique of monitoring assets and benchmarking detailed public well being spending throughout companies and extra time, we lack key instruments to pretty and thoroughly allocate assets and display accountability to the general public.
WHAT DID WE FIND?
In working with observe companions towards the event, pilot testing, and restricted use of UCOA, we frequently heard from practitioners that such a standardized methodology for reporting and evaluating monetary knowledge was necessary for accountability, useful resource allocation, benchmarking, and supporting worth to the general public. well being assets to their communities. We additionally discovered the information generated to be of nice curiosity for inspecting particulars of expenditure and income patterns, monitoring particular funding streams and supporting public well being providers and methods analysis. On the identical time, technical help is clearly wanted to supply the definitions, tips, knowledge visualizations, monetary help, incentives, and knowledge linking obligatory to make sure the uptake and use of UCOA and its associated knowledge.
In our experiences with the event and implementation of the UCOA from 2016-2021, we realized many vital classes that should not be misplaced when the institutionalization of a UCOA turns into a funded nationwide precedence.
Whereas making a UCOA for and with public well being practices, we discovered that the hassle required to cross-reference their monetary knowledge to UCOA is a barrier. For the hassle to be worthwhile for public well being companies, they want the information obtainable to them by way of user-centered visualizations or dashboards and mixed UCOA knowledge from different companies.
The UCOA have to be and stay aligned with different nationwide efforts, together with the Fundamental Public Well being Companies (FPHS) and public well being accreditation. We labored intently with observe and nationwide companions to get the UCOA to mirror FPHS-related spending and supporting companies to satisfy accreditation requirements.
Though we’ve got been in a position to help some restricted analysis with the UCOA knowledge collected, broad software of UCOA is important to supply the wealthy supply of knowledge wanted to explain the kinds of assets public well being companies must for which functions and beneath which circumstances.
As cash pours into public well being methods on the heels of the pandemic, politicians and the general public will (and will) anticipate us to account for the way these assets had been spent and for what objective. We is not going to have such a way to account for assets throughout our methods and extra time with out institutionalizing standardization of monetary knowledge. But asking public well being companies to prioritize their effort and time to cross-reference their monetary knowledge to a UCOA and with out extra assets or incentives is greater than might be anticipated of them. We argue that such institutionalization and even necessary integration of UCOA is accompanied by important implementation assets, technical help, incentives, and user-centered entry to the information they supply.
Our findings and key factors are vital to advancing nationwide efforts to ascertain broad UCOA adoption and are described in our article A Uniform Chart of Accounts: Strengthening Public Well being Apply and Analysis By Standardized Monetary Information. However with out these outcomes and experiences maintained, and with out making the standardization of public well being financial knowledge a funded nationwide precedence, the UCOA we developed and carried out with observe companions from 2016-2021 is not going to serve to information observe or present the accountability we so desperately want. display that public well being authority assets are properly spent.
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- Dada, OO, Bekemeier, B., Flaxman, A, & de Castro, B. (2022). Associations between Native Well being Division Expenditures on Fundamental Capabilities and PHAB Accreditation Customary Scores, Limits in public well being10:861587.
- Yeager VA, Balio CP, McCullough JM, et al. Financing public well being: achievements and challenges in public well being financing because the 2012 Institute of Medicines report. Journal of Public Well being Administration & Apply. 2022;28(1):E244-E255.
- Bekemeier B, Singh SR, Schoemann A. A uniform chart of accounts for public well being companies: an important ingredient for a powerful public well being system. Journal of Public Well being Administration & Apply. 2018;24(3):289-291.
- Bekemeier B, Park SE, Whitman G. Challenges and experiences in selling the adoption of standardized native public well being providers supply knowledge by way of software of the PHAST mannequin. Journal of the American Medical Informatics Affiliation. 2018;26(12):1660-1663.
Elizabeth HeitkemperRN, PhD is an assistant professor on the College of Texas at Austin College of Nursing with particular experience in user-centered design and adaptive informatics instruments to help well being promotion and use knowledge in resolution making. She leads analysis incorporating info know-how into observe for underserved populations.
Dana L. Zaichkin, MHA, PhD, RN, is an affiliate professor at Pacific Lutheran College College of Nursing with experience in well being administration, finance, economics, and public coverage and the applying of those to public well being methods and observe.
Greg Whitman is the Venture Supervisor for Public Well being Actions and Companies Monitoring (PHAST) on the College of Washington College of Nursing. His function with PHAST has been to work intently with companions in public well being observe to develop instruments and assets to acquire, visualize and apply knowledge to observe.
Simone R. Singh, PhD, is an affiliate professor on the College of Michigan College of Public Well being. Her analysis program consists of the costing of public well being providers, together with the productiveness and effectivity of service supply and the influence of expenditure on inhabitants well being outcomes.
Jonathan P. Leider, PhD, is a senior fellow on the College of Minnesota College of Public Well being and founding director of their Middle for Public Well being Techniques. He has a powerful analysis program that features public well being coverage, funding, and workforce improvementopment.
Betty Bekemeier, PhD, MPH, FAAN is a professor on the College of Washington (UW) College of Nursing and director of the Northwest Middle for Public Well being Apply on the UW College of Public Well being. She is a researcher in public well being methods with a concentrate on packages, observe and funds in well being departments.