Objectives
• To determine the proportion of LHDs that have had their
budgets reduced compared to previous fiscal year
• To examine the extent to which LHD budgets have
decreased over the past year
Factors Associated with Recent Budget
Reductions for Local Health Departments
Evidence from Two Nationwide Surveys
• To identify organizational characteristics that are
associated with vulnerability to budget cut
Gulzar H. Shah, PhD, MStat, MS
Carolyn J. Leep, MS, MPH
Barbara Laymon, MPH
Study Design
Study Design (2)
•
Linked data from two cross-sectional nationwide surveys of LHDs
conducted by NACCHO in late 2008
•
National Survey of LHD Budget Changes
– Predominantly census approach (N=2,422)
•with exception of five states, where some sampling was performed to
prevent one individual from receiving multiple surveys
– Respondents = 1,079
•
The 2008 National Profile of LHDs (core questionnaire)
Statistical Methods:
• Bivariate analysis using t-tests/eta-square, chi-square,
Somer’s D and Kendal’s Tau B as appropriate
• Three-way Tables
• Logistic regression of dichotomous variable “whether or
not LHD experienced a budget cut”
– Complete census of all LHDs (N=2,794)
– Respondents = 2,332
Number of LHDs that participated in both surveys =1,021
Results – Whether Budget was Reduced
Results – Whether Budget was Reduced by LHD
Size
Percent of LHDs with reduced current budget
compared with prior year
Percent of LHDs with type of change in current operating year
budget (vs. prior year)
Approximately
same
47.5
50.0
45.0
50%
Percent of LHDs
35.0
30.0
Less
26.5
40%
Greater
26.0
25.0
45%
45%
40.0
Percent of LHDs
•
37%
35%
30%
25%
25%
22%
20%
20%
15%
20.0
10%
15.0
5%
0%
10.0
<25,000
25,000 - 49,999
50,000 - 99,999
5.0
100,000 499,999
500,000 +
LHD size
.0
Nature of budget change
Note: Differences among LHDs in different population size strata were statistically
significant, based on Chi-square and Somers’ d statistic (P<0.000)
Level of Budget Reduction
Jurisdiction Population
Starts at
coast;
moves in
All LHDs
<25,000
25,000 - 49,999
50,000 - 99,999
100,000 - 499,999
500,000+
Starts
at
coast;
moves
in
Budget Decrease
(Current Year vs. Prior)
Median
Mean
6%
9%
6%
10%
10%
10%
9%
9%
5%
7%
5%
9%
Note: Differences among LHDs in different population size strata were
statistically non-significant, based on ANOVA test (P=0.08)
NOTE: At the time of data collection in late 2008, some states were
just entering budget periods, recession not fully recognized
Average Amount of Budget Reduction
Jurisdiction
Population
All LHDs
<25,000
25,000 - 49,999
50,000 - 99,999
100,000 - 499,999
Percent with Reduced Budget by LHD Size and
Governance Category
Budget Decrease
(Current Year vs. Prior)
Median
Mean
$100,000 $480,000
$25,000
$45,000
$70,000 $110,000
$100,000 $180,000
$250,000 $540,000
LHD population
size
<50000*
50000-499999*
500000+
LHD budget
Type of
was less than
governance previous year
40.4%
State
19.1%
Local
59.7%
State
25.4%
Local
50.0%
State
40.0%
Local
* Differences are statistically significant based on Chi-square,
Somer's d and Kendal's Tau B (P<0.01)
Percent with Reduced Budget by LHD Size and
Presence of a Local Board of Health
Presence of
local board
LHD population size of health
<50000
Yes
No
50000-499999*
Yes
No
500000+
Yes
No
LHD budget
was less than
previous year
20.9%
26.5%
25.5%
54.7%
35.3%
46.4%
* Differences are statistically significant based on Chi-square, Somer's d and
Kendal's Tau B (P<0.000)
Total LHD Expenditures and Revenues and
Source-Specific Percentage of Revenues
After controlling for the LHD size (Small, Medium, Large), the
following relationships were noted with budget cut:
•
Larger LHD revenue (+ ; p<0.0001)
•
Larger LHD expenditure (+ ; p<0.0001)
•
Higher percent of revenues from State (direct and federal passthrough) (+ ; p<=0.001)
•
Higher percent of revenues from Federal sources (direct) (+ ;
p<0.0001)
•
Higher percent of revenues from Medicaid (- ; p<0.0001)
•
Higher percent of revenueset from Patient personal fees (- ; p=0.009)
Results of Logistic Regression of Whether LHD
Budget was Reduced (1)
Results of Logistic Regression of Whether the
Budget was Reduced (2)
After controlling for other covariates in the model, the
following variable were significantly associated with
budget cut [listed in the order of effect and with direction of
association]
4. Performing certain emergency preparedness activities (+):
1. Centralized Governance (+ ; 3 times more likely)
2. Employing epidemiologist – (+ ;1.6 times more likely)
3. Percent of revenues from patient personal fees — high (-)
– Reviewed relevant legal authorities to isolate and/or quarantine individuals, groups, facilities,
animals, and food products
– Participated in drills or exercises: functional level
–
Provided emergency preparedness training to staff on NIMS compliance
5. Percent of revenues from State (direct and federal pass-through) –high
(+)
6. Employing nutritionist -- (-)
7. Screening of certain diseases (HIV/STD; Tuberculosis; Cardiovascular
disease) (+)
8. Size of LHD (9 population categories) – (direction
Questions
• Thanks you
• Contact info
– Gulzar H. Shah; email gshah@naccho.org
inconclusive)