Financial Analysis and Structural Considerations to the Problem of Rural Public Health in Pennsylvania

Abstract

Currently, none of Pennsylvania's 48 rural counties has a local health department (LHD). This is despite the existance of laws that provide locales with per capita funding for public health and environmental services. This study examines the financial issues that may influence the establishment of a robust public health infrastructure in rural areas. The study looks at 10 rural counties in the state and, through financial analysis of different LHD models (using the 2003-04 financial data) for rural counties, helps demonstrate that the relatively high levels of local funds required to establish LHDs would be a major financial undertaking. Testing three models - single-county, bi-county and tri-county LHDs - the study shows that locales would require an average of $16 per capita annually in local funds. the model analysis shows that small population size, large geographic area, and the low availability of primary care servics drive expenses higher. Since rural counties have low population density, cover broad geographic expanses, and suffer from chronic lack of primary care services, rural LHDs covering rural counties have to cover a very large geographic area, a critical cost driver especially for environmental services such as water supply testing. Geographically large rural counties are also pressured to provide personal health services given the limited number of primary care providers. The result is a local health department with very high expenses. The paper concludes with policy considerations that may help to overcome these barriers, including establishing secondary formulas that are an alternative to per capita funding as well as creation start-up costs funds.