Uniform Chart of Accounts

Uniform Chart of Accounts: Standardizing Public Health Expenditure Data

Challenge

There is currently no standard way for the over 2800 local public health departments (LHDs) across the nation to account for their revenues and expenditures. This means it is not possible to compare and evaluate spending across agencies and to estimate program and unit costs. Comparisons allow practitioners to identify drivers in the cost variation of public health services and to explain how targeted investments affect service costs. The current system makes it difficult to compare spending in major programs across LHDs because each agency may define a major program differently, or may include different activities within a given major program (e.g., be able to see where they are in relation to other agencies with per capita spending, and determine whether their spending seems like too much or too little).

Solution: Standardization

The Public Health Informatics Institute (PHII) has started work to standardize reporting on public health spending. Additionally, the Public Health Leadership Forum has developed the Foundational Public Health Services (FPHS), identifying which services are “essential to communities everywhere for the health system to work anywhere.”

PHAST, through a grant by the Robert Wood Johnson Foundation, is building upon this work by determining the feasibility of implementing a Uniform Chart of Accounts (Uniform COA) to track public health expenditures and revenue in local and state health departments. Adopting a standardized public health financial data tracking system using a Uniform COA will allow within- and between-state comparisons over time. For example, departments can use it to inform and educate policy makers and the public about challenges from public health spending cuts that followed the recession, demonstrating not just how spending levels have changed, but also that, in many cases, spending levels have never recovered.

Individual public health agency chart of accounts to Chart of accounts crosswalk to Uniform chart of accounts

Current Partners

Our current project encompasses 16 local health departments and their respective state agencies from 4 states: New York, Minnesota, Missouri, and West Virginia

Map of participating states, with their participating local health departments highlighted

What We're Doing

Together, the PHAST team and these 20 participants have developed a Uniform COA, identifying common categories of major programs and program activities within seven broad areas of public health.

Program Areas and Major Programs (Hover over major program names to see definitions)
Communicable Disease Chronic Disease Injury Prevention Environmental Health Maternal-Child & Family Health Access & Linkage Capabilities All Other Activities
HIVServices/activities for the education, surveillance, clinical care, intervention, community planning, and prevention of HIV/AIDS and persons infected with the virus TobaccoServices/activities to decrease access and use of tobacco by youth and adults FallsPlanning, implementing, and evaluating interventions to improve the health of seniors Food safetyServices/activities necessary for the assurance that safe and wholesome food is provided to the public. Includes educational efforts directed toward the public and food service operators/handlers, implementing applicable state and local regulations governing retail food establishments, public education, food handler permits, inspection of food establishments and food processors, investigating complaints of unsafe food handling practices, and taking enforcement actions as needed Family planningServices/activities for family planning and reproductive health issues including services/activities relating to Title X funded family planning and reproductive health activities Health care licensing AssessmentServices/activities related to the regular collection, analysis, and sharing of information about health conditions, risks and resources in the community, monitor health status and risk indicators, health emergencies, environmental risk factors, community concerns, community health resources. Other healthcare
STDServices/activities for the diagnosis, treatment, and control of sexually transmitted diseases CancerServices/activities related to the prevention and control of cancer (e.g., Breast and Cervical Health Program) Motor vehicleLinking crash data with injury data and planning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent injuries, disabilities, or premature death due to motor vehicle crashes

WaterServices/activities related to the planning, development, and on-going operation of safe drinking water systems. Includes conducting plan reviews, carrying out regulatory oversight of public supplies, following up on incidents of water system contamination, and consulting with individual well owners

Environmental Water Quality: Services/activities related to the assessment and protection of overall water resources in the community including surface and ground waters. Includes conducting investigations, collection and analysis of data, identifying pollution sources, developing pollution prevention plans, undertaking remedial actions, responding to area-wide contamination incidents, promoting water resource protection in community, monitoring surface waters including swimming, boating, and shellfish growing areas

Drinking Water Quality: Services/activities related to the planning development and on-going operation of safe drinking water systems. Includes conducting plan reviews, carrying out regulatory oversight of public supplies, following up on incidents of water system contamination, consulting with individual well owners

Newborn screening Eligibility determination All hazards preparedness & responseIncludes: 1. Ability to develop and rehearse response strategies and plans, in accordance with national and state guidelines, to address natural or manmade disasters and emergencies, including special protection of vulnerable populations. 2. Ability to lead the Emergency Support Function 8 – Public Health & Medical for the county, region, jurisdiction, and state. 3. Ability to activate the emergency response personnel in the event of a public health crisis; coordinate  with federal, state, and county emergency managers, and other first responders; and operate within, and as necessary lead, the incident management system. 4. Promote community preparedness by communicating with the public in advance of an emergency about steps that can be taken before, during, or after a disaster. Other social services
TBServices/activities for the diagnosis, treatment, and control of tuberculosis ObesityServices/activities to address the threat of obesity FirearmsPlanning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent injuries, disabilities, or premature death due to firearms AirIndoor Air: Planning, implementing, and evaluating interventions to improve the health of a community by addressing issues related to indoor air quality and health effects from indoor pollutants

Outdoor Air: Planning, implementing, and evaluating interventions to improve the health of a community by addressing issues related to outdoor air quality and health effects from pollutants
Coordination of servicesServices/activities related to coordinating services across departments/organizations with overlapping maternal, child, family health goals Building health care capacity Policy development & support  
HepatitisServices for the diagnosis, treatment and control of chronic Hepatitis B and Hepatitis C cases requiring LHJ investigation and case reporting CardiovascularServices/activities to prevent cardiovascular (heart) disease. Includes heart disease, hypertension, stroke Occupational injuryPlanning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent job-related injuries, disabilities, or premature death SewerageServices/activities related to the planning and provision of safe collection, treatment, and disposal of residential sewage. Services/activities related to the planning and provision of environmentally sound uses of land. Includes environmental reviews of proposed land use projects as well as site evaluations, inspections, investigations of improper sewage disposal, advising planning groups on locating solid waste disposal sites, chemical storage, and pursuing corrective actions Direct servicesServices/activities requiring direct family, or childcare services Other access & linkages Communications  
ImmunizationServices/activities to administer and distribute vaccine for vaccine preventable diseases for individuals of all ages Asthma Intentional injuriesPlanning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent injuries, disabilities, or premature death due to violence other than firearms Vector borneServices/activities related to insect and arthropod related illnesses, rabies investigations, animal bite infections, and other public health services/activities involving zoonotic diseases Supplemental nutritionIncluding WIC: Nutrition education, supplemental foods and referrals to needed health services for pregnant and breastfeeding women, infants, and children under age five who are at nutritional risk   Community partnerships development  
Communicable disease epidemiologyServices/activities related to the investigation into the occurrence and control elements of diseases and health risks in the population DiabetesActivities that implement and evaluate public health strategies to reduce disability and deaths due to diabetes and its complications Unintentional injuries Solid wasteServices/activities related to implementing the waste management priorities of waste reduction, recycling, and disposal, as well as responding to incidents of illegal storage/disposal of solid/hazardous waste. Includes implementing applicable state and local regulations governing the collection, transportation, storage, disposal of solid/hazardous wastes, investigation of complaints, pursuing remedial clean-ups, promoting/implementing waste reduction and recycling effort Population-based maternal-child healthServices/activities related to population based maternal and child public health   Organizational competencies  
Other communicable disease activitiesServices/activities to promote prevention and control of communicable diseases Other chronic disease activitiesServices/activities to promote prevention and control of non-communicable diseases and chronic illnesses Substance abuseServices/activities related to surveillance and tracking of substance abuse rates, assuring the availability of substance use prevention, treatment, and recovery support services and planning, implementing, and evaluating interventions to improve the health of a community LeadServices/activities related to the prevention of lead poisoning through lead abatement licensing, childhood lead testing, and planning, implementing, and evaluating interventions to improve the health of a community Other maternal-child & family activitiesServices/activities for families and individuals that cannot be otherwise categorized. May include Adult Health, School Health, Home Health, Migrant Health, Jail Health, Rural Health, Minority Health, etc.      
    Other injury activities Fish & shellfishServices/activies related to the protection and health of wild fish supply        
      Toxic substance assessmentServices/activities related to evaluation of human exposure to hazardous substances and advising communities and other agencies about minimizing possible advers health effects from exposure to those substances.  Includes testing farm run-off for pesticide levels        
      Other environmental health activitiesServices/activities for promotion or protection of environmental health not otherwise categorized        

We have completed this collaborative process using conference calls and an online survey system. In the ensuing evaluation phase, we will collect feedback from participants about their experiences with the Uniform COA and whether or how they would recommend larger scale implementation.

Use Chart of Accounts

To implement the Uniform Chart of Accounts in your own agency, use the documents provided here:

  • The Uniform Chart of Accounts is a list of major programs and program activities within the seven broad areas of public health.
  • The Uniform COA Crosswalk is a template for matching your agency’s financial data with the Uniform COA.
  • The Effort Estimation Tool is a tool for estimating how FTEs, and thereby personnel expenditures, are distributed among program activities within a major program.
  • The Guidebook includes instructions and definitions for major programs and program activities.

For more information about the Uniform Chart of Accounts or how you can implement the Uniform COA in your agency, check out our feature in the UW School of Nursing or contact Greg Whitman, Project Manager, at phast@uw.edu.