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Senay Goitom Robert M. La Follette School of Public Affairs Andrew M. Reschovsky, PhD

Revenue Generation as Budget Strategy: Predictors of Per Capita Local Health Department Non‐Local Government Revenues. Senay Goitom Robert M. La Follette School of Public Affairs Andrew M. Reschovsky, PhD Robert M. La Follette School of Public Affairs Susan Zahner, DrPH, RN

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Senay Goitom Robert M. La Follette School of Public Affairs Andrew M. Reschovsky, PhD

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  1. Revenue Generation as Budget Strategy: Predictors of Per Capita Local Health Department Non‐Local Government Revenues Senay Goitom Robert M. La Follette School of Public Affairs Andrew M. Reschovsky, PhD Robert M. La Follette School of Public Affairs Susan Zahner, DrPH, RN School of Nursing

  2. Acknowledgments Support for this research was provided by a grant from the Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networksprogram, and A Health Policy Assistantship funded by grant #1UL1RR025011 from the Clinical and Translational Science Award program of the National Center for Research Resources, NIH

  3. Effect of Economic Crisis on LHDs • Housing collapse and “Great Recession” have led to steep budget cuts at all levels of government • In Wisconsin, as in many other states, recent budget deficits have been closed primarily through cuts in spending • In Wisconsin, constraints have been placed on LHDs in the form of property tax levy limits • This will impact the single largest source of revenue for LHDs

  4. Rationale • Given the constraints facing local governments, non-local government sources will become increasingly important • This study represents a first step in understanding the factors affecting these revenue sources

  5. Local Health Departments in WI • In Wisconsin, 94 LHDs provide public health services including: • Communicable disease control • Immunization • Investigation of disease outbreaks • Education • Chronic disease prevention and control • Wellness programs • Environmental health • Water testing • Restaurant and lodging inspections

  6. Research Question • What community and LHD characteristics affect growth of non-local government revenue?

  7. Description of Data • Panel dataset • 92 health departments • Representing 70 counties and 42 municipalities • 2002-2009 • Total panel size N=746 • Includes data from the following sources: • Wisconsin Department of Health Services Local Health Department Survey (2002-2009) • LHD Revenue Data • Local Health Department Inventory • Data on Services Provided • Demographic Data • Wisconsin Department of Revenue • Equalized Property Value Data • Property Tax, Sales Tax, Shared Revenue Data

  8. Local Health Department (LHD) Financing in Wisconsin • In Wisconsin, LHDs receive revenue from the following sources: • County/municipal sources (e.g. taxes) • Fees for services • Federal grants • State grants • Private grants • Donations from individuals Focus of this presentation

  9. Sources of Non-Local Government Revenue • Fees for services • Restaurant and private well inspections • Medicare and medicaid reimbursements • Federal Grants • Maternal and Child Health Block Grant • WIC • State grants • Childhood lead • Well Woman programs • Private grants • Donations from individuals

  10. Percent of Total Revenue 2002-2009

  11. Regression Model • We are looking at why some health departments are obtaining more revenue than others Where: is non-local government sources of revenue is a vector of community characteristics is a vector of LHD characteristics corresponds to a vector of time dummy variables

  12. Estimation Method • Log transformation where appropriate (dependent variable and some RHS variables) • Lag structure • Include one and two year lagged values of dependent variable • Pooled OLS regression • Robust standard errors using LHDs as clusters

  13. Summary Statistics of Variables in Final Model

  14. Regression Results-Community Characteristics Standard errors in parentheses * p < 0.10, ** p < 0.05, *** p < 0.01

  15. Regression Results (cont’d)-LHD Characteristics Standard errors in parentheses * p < 0.10, ** p < 0.05, *** p < 0.01

  16. Interpretation of Regression Coefficients

  17. Policy Implications • Two variables point to possible strategies for health departments • Percent of total services • Whether the LHD is an agent of DHS • The model suggests that changes that increase the number of services provided by LHDs have a positive, statistically significant association with revenue

  18. Contact information • Senay Goitom • goitom@wisc.edu • 312-520-7115 • Andrew Reschovsky • reschovsky@lafollette.wisc.edu • 608-263-0447 • Susan Zahner • sjzahner@wisc.edu • 608-263-5282

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