Review the roles and responsibilities for the various federal public health agen

Question

Review the roles and responsibilities for the various federal public health agencies and list the three that you believe are most important. Then examine the various PHS agency budgets and information in the most recent federal budget. Is your list of the most important federal public health responsibilities consistent with spending levels for public health activities among these federal agencies? If you could allocate resources differently, which agency budgets would you increase and which would you decrease (assuming the total would remain the same)?

Explanation / Answer

Federal, state, and local public health agencies must:
define standards for public health that improve the overall health of the population and provide strategies for achieving greater health system efficiency and effectiveness;

Existing models need to be utilized and new models need to be developed that go beyond the provision of personal health care to enhance the health status of populations. These models require particular emphasis on culturally sensitive personal health delivery systems. One such model is Community-Oriented Primary Care (COPC), which designs and evaluates community health interventions as an integral part of the provision of primary medical care. Many community migrant health centers and other models of integrated practice have developed COPC practices in which personal health services and public health interventions are combined in one organizational model. Such programs have great potential to develop more effective health promotion, social support, and personal health care approaches to all populations.

Even when there are no financial barriers to care, private providers may not meet the needs of all residents or provide the special services and expertise required by high risk populations that are now offered by many public health programs and agencies. Local public health agencies and other community-based organizations may therefore need to continue to serve the needs of these persons, in addition to the agencies' broader role in the health care system as a whole. Particular attention must be paid to assure personal health care for indigent persons not eligible for Medicaid.

Public Health Agency Roles:
Public health functions and agencies exist on the federal, state and local levels. The division of responsibilities and authority varies considerably by state. Nevertheless, at each level of government, the public health agency is responsible for the following essential health services:

The agency must have sufficient capacity and financial support to carry out these functions. The Federal Government's Role is to:

National funding can provide resources necessary for improving the public's health as well as assurance of equity across all the states, so that a person's health doesn't suffer because of his or her place of residence. Past federal funding has concentrated on categorical programs intended to deal with specific problems. Some of these programs have been very important and successful.

However, categorical programs are competitive and not available to all communities. Reliance on such single-focus programs for financing has sometimes left public health agencies with insufficient resources to deal with health threats not included in those categorical programs, and little funding for broad health promotion and prevention efforts. Broader funding, such as a general operations budget, is necessary at all levels to provide the public health system with ongoing capacity to monitor, anticipate, and respond to health problems.

Public health services should be considered part of the social safety net which is the responsibility of government to provide for all people. Stable funding is also necessary. One way of ensuring stable funding is by requiring organizations and institutions paying for personal health services to support public health in proportion to the amount they spend on personal health care.

State governments have carried a major responsibility for governmental health activities. The scope of these activities, and the organizational entity within the state government responsible for them, varies from state to state. Variation among the more than 3,000 local public health agencies is even greater. They range from large autonomous comprehensive agencies in some major metropolitan areas to small agencies primarily in rural areas. Several political jurisdictions may be served by a jointly sponsored multi-county or city-county agency. The relationship of these agencies to their state agencies is complementary, and varies widely. The local health agency's scope of programs is generally more limited than the state's and the extent of its autonomy varies, although local health agencies remain the point of service for most public health programs and functions.

PHS agency budget

The primary source of funding for each PHS agency is the discretionary budget authority it receives through the annual appropriations process. AHRQ, CDC, HRSA, NIH, and SAMHSA are funded through the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-ED) appropriations act. Funding for ATSDR and IHS is provided through the Department of the Interior, Environment, and Related Agencies (Interior/Environment) appropriations act. FDA gets its funding through the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Agriculture) appropriations act.8 The economic stimulus package enacted in February 2009—the American Reinvestment and Recovery Act (ARRA)—provided a total of $15.1 billion in supplemental FY2009 discretionary appropriations to five of the PHS agencies. Details of the allocation of those funds are provided. Almost all of the ARRA appropriations were designated as two-year funds, available for obligation through the end of FY2010. Transfers The annual Labor-HHS-ED appropriations act gives the HHS Secretary limited authority to transfer funds from one budget account to another within the department. The Secretary may transfer up to 1% of the funds in any given account. However, a recipient account may not be increased by more than 3%. Congressional appropriators must be notified in advance of any transfer.

The Patient Protection and Affordable Care Act (ACA)16 included numerous appropriations that together are providing billions of dollars in mandatory spending to support new and existing grant programs and other activities. Some of the ACA appropriations fund specific programs and activities within the PHS agencies. These appropriations are itemized in the funding tables in this report. The ACA also established three multibillion dollar trust funds to help support PHS agency programs and activities. First, the Community Health Center Fund (CHCF), for which the ACA provided a total of $11 billion in annual appropriations over the five-year period FY2011- FY2015, is supporting the federal health centers program and the National Health Service Corps (NHSC), both administered by HRSA. Second, the Prevention and Public Health Fund (PPHF), for which the ACA provided a permanent annual appropriation, is intended to support prevention, wellness, and other public health programs and activities. To date, CDC has received the majority of PPHF funds, while AHRQ, HRSA, and SAMHSA have received smaller amounts. The HHS Secretary transferred almost half of the FY2013 PPHF funds to CMS to support ACA implementation The Patient-Centered Outcomes Research Trust Fund (PCORTF) is supporting comparative effectiveness research over a 10-year period (FY2010-FY2019) with a mix of appropriations— some of which are offset by revenue from a fee imposed on health insurance policies and selfinsured health plans—and transfers from the Medicare Part A and Part B trust funds.21 A portion of the PCORTF is allocated for AHRQ. In addition to the ACA funding, HRSA, CDC, and IHS each receive mandatory funds from other sources. HRSA’s Family-to-Family Health Information Centers Program has been funded by a series of mandatory appropriations since FY2007; CDC receives Medicaid funding to support the Vaccines for Children program; and both IHS and NIH receive mandatory funds for diabetes programs. These and other mandatory appropriations are itemized in the agency funding tables in this report.

For more information on allocation of budget, refer website - https://fas.org/sgp/crs/misc/R43304.pdf

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