William F. Pilkington's thesis
Risk, Politics, and Money: Need for A Value-Based Model for Financing Public Health Preparedness
– Executive Summary –
This research pointed to significant problems in the public health preparedness system for which there are no easy solutions. Budgets are extremely tight and staffs are strained. Most of the public health preparedness funding comes from one federal grant (PHEP) that has been declining every year for the last seven years. There is only one national program that recognizes preparedness competency and very few LHDs have received recognition. During the past several years, a number of public health emergencies ranging from pandemics to hurricanes have seriously challenges the preparedness capacity of LHDs. A persistent theme in the literature review was the need for local health departments to be better prepared to respond to both natural and man-made events.
Since 9/11, political considerations have dominated homeland security decisions. The political model does not consider risk, benefit, or even effectiveness. Instead, large sums of public money have been appropriated and spent on homeland projects, equipment, and programs without any concrete evidence that they improve our security. Very little consideration has been given to using analytical or economic tools that can be used to demonstrate effectiveness.
In the absence of any analytical processes, it is likely that the expenditure of public dollars will continue to be determined mostly within the framework of the political model. Furthermore, unless an acceptable alternative appears, it is likely that the willingness to change to a more innovative rational decision-making model will be overshadowed by the coalitions that control homeland security funding policies.
In contrast to the political model, this thesis developed a value-based model for financing public health preparedness. This model is the antithesis of the political model because it is built upon the foundations of analytical decision-making. The essential tools of value-based decision-making (VBDM), for the purposes of this research, are risk assessment, cost-benefit analysis, cost-effectiveness analysis, return on investment, and hazard vulnerability analysis. These tools are “value-based” because they provide a rational basis for evaluating the cost, consequence, and utility of specific funding decisions.
In an effort to understand the relationship between value-based decision-making and public health preparedness competency, 500 local health departments were randomly drawn using strata to randomly generate numbers.
This research project was unable to confirm the idea that value-based analytics improve the decision-making process for financing public health preparedness. The essential components of a new value-based model are national preparedness standards, use of common analytics, and political buy-in. Each of these components must overcome implementation hurdles before value-based decision-making can be deemed a successful alternative to the existing political model.
This research corroborated the need for system level change but emphasized individual departmental programmatic changes related to the investment in the public health preparedness infrastructure, the need for a budget and outcome tool, and the use of value-based decision-making as an analytical tool for prioritizing spending decisions. These changes can be viewed as recommendations that provide the foundation for developing a new value-based model for financing public health preparedness.