Date of Award

12-2013

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Dr. Kieran Fogarty

Second Advisor

Dr. Mark Messonnier

Third Advisor

Dr. Robert Wertkin

Fourth Advisor

Dr. Ann Dozier

Keywords

Public health, value measure, economics, system change

Abstract

In this time of economic downturn, it is becoming increasingly important for organizations, including those in public health, to “prove their worth,” to show the value in improvement strategies. Health agencies have learned to discuss impact in terms of health outcome and mortality/morbidity measures. However, it is critical that these impacts are also expressed in a way that shows cost-efficiency and economic benefit especially for promising, evidence-based public health interventions. Although several methods of economic evaluation including cost-effective analysis, cost-utility analysis, or cost-benefit analysis and return on investment (ROI) have been used in social sciences and health research, fewer examples are found in public health systems research.

This dissertation explores common methods for financially quantifying value in public health system change, and these methods are used to assess cost-benefit in a real-world example: the development of the Center for Community Health (CCH), an academic–public health partnership anchored in the University of Rochester Medical Center (URMC). The value of the University’s investment in public health is analyzed by quantifying the costs and benefits of the Center. A multi-methods, retrospective analysis of this naturally occurring experiment was conducted including collecting revenue data (internal and extramural) and expenses data over time, as well as interviewing key informants to quantify the Center’s contribution to the Essential Services of a public health department.

With the University’s annual contribution of around $1 million, the CCH has accumulated a $6.5 million annual budget within 6 years. This has resulted in an expanded public health workforce of 60 individuals and increased essential public health services delivered to the community including surveillance, research, policy investment, cancer screenings, prevention programs, and individual counseling. In addition to the increased budget and shifting to extramural funding, the CCH has achieved cost-effectiveness through disease prevention through programs and services.

This work serves as a practical and duplicable example for public health practitioners and systems researchers of how economic analysis of system chance can be done. An analytical framework is presented, as well as a discussion of barriers and shortcomings for measuring value in public health interventions.

Access Setting

Dissertation-Open Access

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