Measuring The Efficiency of Public Health Programs: The Example of Immunization Control Programs

David B. Rein, PhD¹, Amanda Honeycutt, PhD¹, and Lucia Rojas-Smith, DrPH². (1) Division for Health Services and Social Policy Research, Health Economics and Financing, RTI International, 2951 Flowers Road, Suite 119, Atlanta, GA 30341, 770-234-5035, drein@rti.org, (2) Health Economics Research Division, RTI International, 1615 M Street N.W., Washington D.C., DC 20036-3208

Objective: The CDC through section 317 Public health service grants, funds the operations of state and local immunization programs. The goal of this spending is to increase child immunization coverage rates and individual programs pursue this goal in different ways. Federal regulations (OMB PART) will require federally funded programs to demonstrate yearly efficiency improvements, but currently no efficiency measure exists. This paper examines ways conceptually to define immunization program efficiency, presents a measure of efficiency, and then adjusts this measure for program level differences.

Methods: 317 Financial Assistance dollars per child aged 3 and under were defined as program inputs. Program outcomes were defined based on two measures of vaccine coverage rates. Using a scatter plot programs were categorized into one of four groups; 1) below average spending and above coverage; 2) above average spending and above average coverage; 3) below average spending and below average coverage; and 4) above average spending and above average coverage. An efficiency measure was derived based on inputs verses outputs, and OLS regression was used to adjust this measure for confounding variables.

Results: Regional and population differences explained a great of variation in program efficiency. However, after controlling for confounding variables differences in program efficiency though reduced, was not eliminated.

Conclusions: Despite programmatic differences, immunization spending can be compared in terms of efficiency based on defined performance measures. Still it is important to recognize that large differences in raw program efficiency scores are caused by systematic differences that make immunization more difficult in some places than in others.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to

Understand the difficulties of defining and measuring the efficiency of public health programs.
Understand the value over the minimum measure of efficiency.
Understand how using raw unadjusted efficiency measures may lead to serious errors in concluding which programs are more efficient.

Keywords: Evaluation, Immunizations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Linking Public Health Program Activities to Health Outcomes: Econometric Approaches (Update on Health Services Research)

The 132nd Annual Meeting (November 6-10, 2004) of APHA