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Estimated Expenditures for Essential Public Health Services -- Selected States, Fiscal Year 1995

Essential public health services are activities that public health departments and other partners undertake to protect and ensure the health of the public. To characterize expenditures for those services and to distinguish within them expenditures for personal health-care services from community-based health services directed toward populations, the Public Health Service (PHS) and the Public Health Foundation surveyed senior health officials in eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas, and Washington {combined 1995 population: 57.8 million} *) (1). This report summarizes the results of that survey, which indicate that spending on community-based health services is a small proportion of spending on essential services and an even smaller proportion of total health-care expenditures.

The eight states were selected to reflect geographic and population diversity and the scope of public health responsibilities and differing organizational relations among their health agencies. Senior public health officials in each state used standard forms and objectives to provide state-specific total public health expenditures and expenditures associated with the 10 essential public health services (see box(Table_1)). Expenditures for the sixth essential service were subdivided: linking persons to needed personal services was separated from assuring the provision of care when otherwise unavailable. Respondents provided estimates of expenditures by public health, mental health, substance abuse, and environmental agencies for essential services during fiscal year 1994 or 1995. Mental health expenditures were based on fiscal year 1993 data collected by the National Association of State Mental Health Program Directors.

During 1994 or 1995, the eight states spent an estimated $8.0 billion on essential public health services; personal health care accounted for $5.5 billion (69%) of this total. Per capita expenditures for essential public health services by state and local public health agencies ranged from $51 to $219 (median: $123). Of these expenditures, per capita expenditures for personal health-care services ranged from $29 to $169 (median: $72). Mental health expenditures constituted 42%-88% (median: 70%) of personal health-care expenditures. Expenditures for community-based health services were $16 to $53 (median: $31) per capita or 0.6% to 1.9% (median: 1.2%) of total 1993 health-care expenditures (2) in each of the eight states.

Reported by: J Dillenberg, Arizona Dept of Health Svcs. C Atchison, Iowa Dept of Public Health. E Baumgartner, Louisiana Dept of Health and Hospitals. B DeBuono, New York State Dept of Health. E Hill, Oregon Health Div. P Nolan, Rhode Island Dept of Health. D Smith, Texas Dept of Health. B Miyahara, Washington State Dept of Health. Public Health Foundation, Washington, DC. Health Resources and Svcs Administration, and Office of Disease Prevention and Health Promotion, Public Health Svc; Office of Public Health and Science, US Dept of Health and Human Svcs.

Editorial Note

Editorial Note: The findings in this report indicate the predominance of personal health services in the public health systems of the states participating in this survey: more than $2 of every $3 spent by the eight states on essential public health services was for personal health-care services. Spending for population-based services accounted for only 1% of total health-care expenditures. These findings provide baseline estimates of public health expenditures, which can be used to develop policy and determine resource allocations.

The findings in this report are subject to at least three limitations. First, the estimated expenditures are based on data from a small, nonrandom sample of states that may not be representative of all states. In particular, the availability and use of resources for essential public health services may vary in relation to public priorities, revenue sources, and other factors. Second, although the essential services were explicitly defined, there were state-specific differences in statutory responsibilities and organization of state public health agencies that in turn were associated with variations in expenditures for and interpretations of the essential public health services. Finally, the ability of the eight states to compile local expenditure data varied. PHS is refining the methods used to estimate expenditures for essential public health services and will directly estimate local essential public health service expenditures.


  1. Public Health Foundation. Measuring expenditures for essential public health services. Washington, DC: Public Health Foundation, 1996.

  2. Alecxih KL, Rutkin D. State-level estimates of health-care expenditures. Arlington, Virginia: Lewin-VHI, 1993.

    • Three states reported expenditures for 1994 and six for 1995. Illinois also was surveyed but is excluded from all analyses reported here because of missing local health department data.
      Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

      Public Health Responsibilities and Essential Public Health Services, 1994
      Public Health Responsibilities:
      -- Prevent epidemics and the spread of disease.
      -- Protect against environmental hazards.
      -- Prevent injuries.
      -- Promote and encourage healthy behaviors and mental health.
      -- Respond to disasters and assist communities in recovery.
      -- Assure the quality and accessibility of health services.
      Essential Public Health Services:
      -- Monitor health status to identify and solve community health problems.
      -- Diagnose and investigate health problems and health hazards in the
      -- Inform, educate, and empower people about health issues.
      -- Mobilize community partnerships and actions to identify and solve
         health problems.
      -- Enforce laws and regulations that protect health and ensure safety.
      -- Link people to needed personal health services and assure the provision
         of health care when otherwise unavailable.
      -- Assure a competent public health and personal health-care workforce.
      -- Evaluate effectiveness, accessibility, and quality of personal and
         population-based health services.
      -- Develop policies and plans that support individual and community health
      -- Research for new insights and innovative solutions to health problems.
      Source: Essential Public Health Services Work Group.

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