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.
| Capabilities | Program Areas | |||||||
|---|---|---|---|---|---|---|---|---|
| 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 | ||
| All Hazards Preparedness and Response | Major Programs | Communicable Disease Epidemiology | Asthma | Firearms | Air | Coordination of Services | Eligibility Determination | Other Health Services |
| Assessment | Hepatitis | Cancer | Motor Vehicle |
Fish and Shellfish |
Direct Service | Health Care Licensing | Other Social Services | |
| Communications | HIV/AIDS | Cardiovascular | Occupational Injuries | Food Safety | Family Planning | Other Access to and Linkage with Clinical Care | ||
| Community Partnerships Development | Immunization | Diabetes | Senior Falls Prevention | Hazardous Substances and Sites | Newborn Screening | |||
| Organizational Competencies | Sexually Transmitted Diseases | Obesity | Substance Abuse | Lead | Population-based Maternal, Child and Family Health | |||
| Policy Development and Support | Tuberculosis | Tobacco | Other Intentional Injuries | On-Site Wastewater | Supplemental Nutrition | |||
| Other Capabilities | Other Communicable Disease Control | Other Chronic Disease Activities | Other Unintentional Injuries | Solid and Hazardous Waste | Other Maternal, Child, and Family Health | |||
| Water | ||||||||
| Zoonotic | ||||||||
| Other Environmental Public Health | ||||||||
Background
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.