Costs of Foundational Public Health Services


The Institute of Medicine’s 2012 report on public health financing called for the convening of expert panels to identify the components of a “minimum package” of public health services and cross-cutting capabilities that should be available in every U.S. community to protect and improve population health, and to identify the resources required to make these services universally available across the country.  With support from the RWJF, an expert panel developed an initial set of definitions for Foundational Public Health Services (FPHS), informed by state-level definitions developed in Washington, Ohio, and Colorado.  The NCC used an expert panel process to develop a methodology for estimating the costs required to implement the FPHS at national, state and local levels.  

The FPHS Cost Estimation Methodology uses a self-administered survey instrument to capture information from state and local public health agency administrators about the labor and non-labor resources currently used by their agencies to implement activities specified in the FPHS definitions. The survey was pilot-tested with public health agencies in Kentucky, and is now being fielded with a national sample of state and local public health agencies to generate national estimates of cost and resource requirements. Two-stage stratified sampling is used to adequately represent states with centralized, decentralized, and shared intergovernmental administrative structures for public health delivery, and to represent local public health agencies serving a range of population sizes.  Two centralized states (AR, SC), three shared-administration states (KY, FL, GA), and three decentralized states (NY, CA, OH) are included in the sample, and within each state at least three local public health agencies are sampled from three different population strata (<50k, 50-299k, >300k). Data collection is ongoing, and separately collected data from a Washington state PBRN study using a similar methodology will be incorporated into the modeling and estimation. 

Preliminary Findings

  • per capita cost to provide foundational public health services ranges from $39 to $90
  • projected per capita cost to fully implement services consistent with expert panel recommendations ranges from $54 to $149
  • estimated per capita value of the gap between current and projected costs ranged from $ -17 to $ 92

Research Brief