Standardizing Public Health Financial Data
Uniform Chart of Accounts Phase 2
How can public health leaders make sure they are using money most effectively?
Which programs are the most efficient?
What is the overall cost of providing essential services, and where does the funding come from?
To answer these and related questions, public health leaders need to be able to compare finances across health departments. But there is currently no standard for the over 2800 local public health departments (LHDs) in the United States to account for their revenues and expenditures.
Through a grant from the Robert Wood Johnson Foundation, the project provided:
- Comprehensive training
- Technical assistance
- Peer learning community support
- An online data entry portal
- Interactive data visualizations
No Change to Existing Systems
The uniform COA is intended to complement—but not replace—existing financial accounting systems.
Expenditures and revenues are broken down into Major Programs and Capabilities as shown in the table below. Participating LHDs crosswalk—or map—the corresponding categories from their accounting systems into the uniform COA categories.
|Communicable Disease Control||Chronic Disease Prevention||Injury Prevention||Environmental Public Health||Maternal, Child, and Family Health||Access to and Linkage with Clinical Care||Other Major Programs|
|Includes: 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.||Major Programs||Services/activities related to the investigation into the occurrence and control elements of diseases and health risks in the population||Asthma||Planning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent injuries, disabilities, or premature death due to firearms||Indoor 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
|Services/activities related to coordinating services across departments/organizations with overlapping maternal, child, family health goals||Eligibility Determination||Other Health Services|
|Services/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.||Services for the diagnosis, treatment and control of chronic Hepatitis B and Hepatitis C cases requiring LHJ investigation and case reporting||Services/activities related to the prevention and control of cancer (e.g., Breast and Cervical Health Program)||Linking 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||
Services/activies related to the protection and health of wild fish supply
|Services/activities requiring direct family, or childcare services||Health Care Licensing||Other Social Services|
|Communications||Services/activities for the education, surveillance, clinical care, intervention, community planning, and prevention of HIV/AIDS and persons infected with the virus||Services/activities to prevent cardiovascular (heart) disease. Includes heart disease, hypertension, stroke||Planning, implementing, and evaluating interventions to improve the health of a community and reduce or prevent job-related injuries, disabilities, or premature death||Services/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||Services/activities for family planning and reproductive health issues including services/activities relating to Title X funded family planning and reproductive health activities||Other Access to and Linkage with Clinical Care|
|Community Partnerships Development||Services/activities to administer and distribute vaccine for vaccine preventable diseases for individuals of all ages||Activities that implement and evaluate public health strategies to reduce disability and deaths due to diabetes and its complications||Planning, implementing, and evaluating interventions to improve the health of seniors||Services/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||Newborn Screening|
|Organizational Competencies||Services/activities for the diagnosis, treatment, and control of sexually transmitted diseases||Services/activities to address the threat of obesity||Services/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||Services/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||Services/activities related to population based maternal and child public health|
|Policy Development and Support||Services/activities for the diagnosis, treatment, and control of tuberculosis||Services/activities to decrease access and use of tobacco by youth and adults||Planning, 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||Services/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||Including 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|
|Other Capabilities||Services/activities to promote prevention and control of communicable diseases||Services/activities to promote prevention and control of non-communicable diseases and chronic illnesses||Other Unintentional Injuries||Services/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||Services/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.|
|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, 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
|Services/activities related to insect and arthropod related illnesses, rabies investigations, animal bite infections, and other public health services/activities involving zoonotic diseases|
|Services/activities for promotion or protection of environmental health not otherwise categorized|
The National Academy of Medicine identified the need for a public health uniform chart of accounts in 2012. Soon thereafter, the Public Health Informatics Institute (PHII) started work to standardize reporting on public health spending. The PHII developed a uniform chart of accounts in line with the Foundational Public Health Services model developed by the Public Health Leadership Forum.
Through a grant from the Robert Wood Johnson Foundation, PHAST built on this work with a pilot study to assess the feasibility of implementing a Uniform COA in governmental public health departments. Four state health departments and four LHDs in each of these states participated in the project. Together, the PHAST team and these 20 participants developed a Uniform COA, identifying common categories of major programs within seven broad program areas of public health, as well as cross-cutting capabilities. All participating organizations were able to successfully crosswalk their financial data to the Uniform COA for their most recent closed fiscal year, and a majority were also able to at least partially automate the crosswalk process.
In Phase 2 of the project, PHAST advanced the adoption of a uniform COA across the United States. Widespread use of a standardized public health financial data tracking system will allow within- and between-state comparisons over time. This system has the potential to increase transparency and accountability for investments made in public health and ultimately can contribute to improved performance of the public health system.