In preparing for this week’s blog I spent some time speaking with my district’s Administrator on financial management topics of concern to local health departments (LHD). During this conversation, I learned that local public health clinics are getting reimbursed for the same medical care given in the private industry but at a much lower rate or not at all.
Most people think that public health services are free. However, U.S. public health funding has been steadily declining over the past several years and clinical services have been part of those cuts.
An example of these cuts to clinical services occurred within the Georgia Department of Public Health (DPH) in 2014. This significant loss of funding has led to a massive restructuring in how health services are funded and provided at all 159 local county health departments in Georgia. The Title X Family Planning program funded by the U.S. Department of Health and Human Services (HHS) was created in 1970 as part of the Title X of the Public Health Service Act and provides “individuals with comprehensive family planning and related preventive health services”. Instead of these funds being awarded to DPH like they had historically been done, the funds were awarded to a consortium of federally qualified health centers (FQHCs) based out of Atlanta that provided more than 170 locations around the state. This was a loss of $7.8 million over a three-year period for DPH but with the cost of restructuring and the loss of patients the cost is most likely higher.
According to a report published in 2014 by NACCHO, LHDs need to earn revenue “through third-party reimbursement” to help ensure that they are able to “provide essential services, conduct core public health functions, and improve the health and well-being of their communities”. This report also states that one of the biggest barriers is that with the Affordable Care Act (ACA) there is a “push towards the “medical home” or using primary care providers with bundled payments for managed care. Due to this shift in service delivery, private insurance companies may not recognize health departments’ clinical services as part of the medical home”.
So what happens when public health funds are cut left and right and they are told to earn revenue but insurance companies won’t play with them because of how the ACA was written?
Last month, the CDC reported that the total number of STD cases in the U.S. had reached an all time high. They attribute some of this increase to fewer public health clinics and reduced access to STD testing and treatment. If we don’t find a way to properly fund our LHDs, reports like this will just continue.
References:
- Himmelstein, D. U., & Woolhandler, S. (2016). Public Health’s Falling Share of US Health Spending. AJPH, 106(1), 56-57. http://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302908
- Miller, A. (2014, 7 18). State agency loses federal “family planning” grant. Retrieved from http://www.georgiahealthnews.com: http://www.georgiahealthnews.com/2014/07/state-loses-federal-family-planning-grant/
- Office of Population Affairs. (n.d.). Title X Family Planning. Retrieved from http://www.hhs.gov: http://www.hhs.gov/opa/title-x-family-planning/
- NACCHO. (2014). Billing for Clinical Services: Health Department Strategies for Overcoming Barriers. Retrieved from http://archived.naccho.org/topics/HPDP/billing/upload/issuebrief_billing_jan2014.pdf
- CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2016, October 19). 2015 STD Surveillance Report Press Release. Retrieved from https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html
Amber Erickson, MPH 
Amber, This is excellent perspective. It demonstrates the importance of systems thinking in policy, or perhaps more directly, unintended consequences. If you are interested in this, you might consider writing a paper on this topic. I would be happy to assist!
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I am definitely interested. I will email you this week.
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I wasn’t aware that public health reimbursement was so much lower than other health agencies providing the same services. I’m glad your administrator was able to enlighten you with that discussion. I may try and ask my administrator the same question just to generate some conversation.
Were you aware that this year, Georgia’s healthcare exchange only has Kaiser and Blue Cross Blue Shield, both of which the Department of Public Health do not have contracts for reimbursement with? “Blue Cross Blue Shield of Georgia is the only carrier that will offer exchange plans in all 159 counties in Georgia.” This could be devastating for public health, and I’m shocked that this hasn’t been discussed with more attention!
Source: https://www.healthinsurance.org/georgia-state-health-insurance-exchange/
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Gurleen, I was aware of the exchange issues here in Georgia as that has been a topic of conversation for many of our rural health departments lately. BCBS of GA is the main insurer for all government employees in GA (i.e., teachers, first responders, etc.) not just public health. Not being able to accept these insurances becomes even more of an issue for counties that do not have any healthcare providers within the county outside of the local health department. Just last month we had someone present to one of our more rural health departments with heart attack symptoms because they knew at least there was a nurse there and they could assist until an ambulance arrived. Luckily our nurse was able to assist but had that person gone to a regular provider the provider would have been able to charge their insurance whereas public health doesn’t qualify for those reimbursements.
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