Public Health Spending and Medicaid Generosity: Short Term Impact on Population Health

Year: 2012
Funding: Jr Investigator Award
Status: Completed


Prior research has established that low levels of per-capita spending on the part of local health departments (LHD) is detrimental to long term population health; however, there is scant evidence of how spending decisions impact population health in the short term. It is also unclear how Medicaid generosity affects the impact of LHD spending on health. This project proposes a longitudinal analysis of secondary data to address three main questions: How does per-capita LHD spending impact population health outcomes in the short term? How does state Medicaid generosity modify the relationship between public health spending and population health? And how does the impact of spending on health vary by the type of public health challenge? For each question, it is assumed that the effects of LHD spending and Medicaid generosity are limited to residents of the jurisdiction in which they are applied. This project is relevant to several points on the most recent PHSSR agenda, specifically those addressed by questions 5 and 10 in section 2A and by question 5 in section 3B. Data for this analysis will come from all available NACCHO LHD profile surveys, from corresponding years of AHRQ data on local hospitalizations and emergency department visits, and from Census Bureau data on Medicaid generosity. A longitudinal mixed effects model stratified by Medicaid generosity and public health challenge will be used to address the main research questions. Results of this study are intended for use by local public health practitioners, policy makers, and fellow researchers interested in the protection and improvement of public health through public policy.


Maggie Paul, M.S.


Patrick Bernet, Ph.D., M.P.A.
Associate Professor of Healthcare Management
Florida Atlantic University’s College of Business