Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System.

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.

Socioeconomic impact and sufficiency of government financial support during COVID-19 pandemic: A retrospective study.

This study examines the socioeconomic impact of the COVID-19 pandemic and the sufficiency of government support. Based on an online survey with 920 respondents, the cross-tabulation and binary logistic regression results show: firstly, in terms of loss of income, male respondents are more likely to have a loss of income as compared to female counterparts, and secondly, among different categories of employment status, the self-employed respondents are the most vulnerable group, given that more than 20 percent of them experienced loss of income due to the COVID-19 pandemic. Moreover, respondents working in small-and-medium enterprises (SMEs) and the informal sector are more likely to face loss of income as compared to respondents working in other sectors of employment. Likewise, respondents without tertiary education level are more likely to have a loss of income as compared to respondents with university certification. The baseline results highlight the insufficiency of government financial support programs based on the perspective of Malaysians from different demographic backgrounds. As a policy implication, the findings could guide the State in formulating the right policies for target groups who need more assistance than others in the community.

Cuts to high-profile NIH efforts leave researchers reeling.

Drop in 21st Century Cures Act funding will slow BRAIN and All of Us projects.

Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector.

The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing.

The impact of digital inclusive financial development on local government expenditure: Evidence from China.

This paper investigates the impact of digital inclusive financial development on local government expenditure incentives at the income level. It does so by constructing a multi-level government Dynamic Stochastic General Equilibrium (DSGE) model that incorporates the financial sector. By employing empirical methods that involve uncertainty shocks and counterfactual simulations, the research yields several key findings. Firstly, the development of digital inclusive finance contributes to breaking down the urban-rural dual financial structure, thus facilitating balanced economic development within regions. Secondly, it reduces the proportion of financially excluded areas, accelerates fiscal decentralization, leading to an increase in local government fiscal revenue, and, consequently, an expansion of local fiscal expenditures. Thirdly, at a certain stage of digital inclusive finance development, it tends to crowd out residents' investment and consumption. Therefore, the decentralization of fiscal power and the expansion of local government expenditure at this stage may paradoxically inhibit regional economic growth. The study's conclusions validate the significant impact of digital inclusive finance on local government incentives at the income level.

Government infrastructure investment stimulation through booming natural resources: Evidence from a lower-middle-income country.

The dynamics of central government funding to regions depend on local investments. In regional autonomy, local governments are encouraged to be more self-reliant from the central government. For regions with high natural resource yields, they will not encounter difficulties in meeting their fiscal needs. Community welfare can be realized through fulfilling basic needs, one of which is infrastructure development. High-quality infrastructure will be able to contribute to further progress in trade, thus enhancing production efficiency. The objective of this research is to analyze the extent of the influence of central government transfer funds, especially the Natural Resource Revenue Sharing Funds (DBH SDA), on local government investments in infrastructure across 508 districts/cities in Indonesia. The method used is dynamic panel regression using the Generalized Method of Moment (GMM) Arellano-Bond approach. This study finds that the role of DBH SDA is still low in infrastructure spending. The role of the central government remains significant in determining infrastructure spending at the district/city level in Indonesia. This indicates that local governments rely more on other sectors in infrastructure investment. By enhancing the role of DBH SDA through technological advancements, it is hoped that the market value of natural resources can be higher through resource downstreaming. This strategy will have broader impacts, as labor needs can be absorbed not only in raw material production activities but also in the processing technology sector. Furthermore, the utilization of natural resources with modern technology can increase extraction efficiency, support sustainable development, and minimize environmental impacts.

Evolution of public funding since primary care research was considered as a priority research domain in france.

PURPOSE: Annually, the French Ministry of Health funds clinical research projects based on a national call for projects. Since 2013, the Ministry has prioritized funding of primary care. Projects selected for funding are made public without distinguishing the specific area of research. The objective of this study was to identify and describe the evolution of the primary care research projects funded by the Ministry of Health between 2013 and 2019. METHOD: We reviewed all of the 1796 medical research projects funded between 2013 and 2019 and categorized projects as primary care projects by using a list of specific keywords. This list was established through two approaches: (1) selected by an expert committee, the RECaP primary care working group, and (2) using an automated textual analysis of published articles in the field. The keywords were used to screen the titles of the medical research projects funded. The abstracts (at www. CLINICALTRIALS: gov ) or details (from project leaders) were then analyzed by two independent reviewers to determine true primary care projects. RESULTS: Finally, 49 primary care projects were identified, representing 2.7% of all medical research projects funded, without any significant change over the period. These projects were predominantly interventional (69%), with a median number of patients expected per project of 902. CONCLUSION: Despite the prioritization of primary care research in 2013 by the French ministry of health, the number and proportion of projects funded remains low, with no significant change over the years. TRIAL REGISTRATION: Not applicable.

Local government spending and mental health: Untangling the impacts using a dynamic modelling approach.

This study investigated the impact of local government spending on mental health in England between 2013 and 2019. Guided by the "Health in All Policies" vision, which encourages the integration of health in all decision-making areas, we explored how healthcare and multiple nonmedical budgeting decisions related to population mental health. We used random curve general cross-lagged modelling to dynamically partition effects into the short-run (from t to t + 1) and long-run (from t to t + 2) impacts, account for unobserved area-level heterogeneity and reverse causality from health outcomes to financial investments, and comprehensive modelling of budget items as an interconnected system. Our findings revealed that spending in adult social care, healthcare, and law & order predicted long-term mental health gains (0.004-0.081 SDs increase for each additional 10% in expenditure). However, these sectors exhibited negative short-term impulses (0.012-0.077 SDs decrease for each additional 10% in expenditure), markedly offsetting the long-term gains. In turn, infrastructural and environmental spending related to short-run mental health gains (0.005-0.031 SDs increase for each additional 10% in expenditure), while the long-run effects were predominantly negative (0.005-0.028 SDs decrease for each additional 10% in expenditure). The frequent occurrence of short-run and long-run negative links suggested that government resources may not be effectively reaching the areas that are most in need. In the short-term, negative effects could also imply temporary disruptions to service delivery largely uncompensated by later mental health improvements. Nonetheless, some non-health spending policies, such as law & order and infrastructure, can be related to long-lasting positive mental health impacts.

[Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System]. / Efeitos das emendas parlamentares no financiamento municipal da atenção primária à saúde do Sistema Único de Saúde.

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

O objetivo deste artigo é analisar os efeitos da ampliação do repasse federal de emendas parlamentares no financiamento municipal da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS), no período de 2015 a 2020. Foi realizado estudo longitudinal com dados secundários de transferências por emendas parlamentares do Ministério da Saúde e de despesas com recursos próprios dos municípios, aplicadas em ações e serviços públicos de saúde e na APS. O efeito do repasse de emendas parlamentares no financiamento municipal foi verificado de forma estratificada por porte populacional dos municípios, por meio de modelos de equações de estimativas generalizadas. O repasse de emendas parlamentares para a APS apresentou grande discrepância de valores per capita entre os municípios de diferentes portes populacionais. Observou-se inexistência de correlação com a despesa municipal em ações e serviços públicos de saúde nos municípios com mais de 10 mil habitantes e associação inversa com a despesa em APS (p < 0,050) em todos os grupos. Conclui-se que o aumento do repasse de emendas parlamentares pelo Ministério da Saúde favoreceu a redução da alocação de receitas municipais com APS, que podem ter sido direcionados para outras finalidades de gasto no SUS. Tais mudanças parecem refletir prioridades estabelecidas para a despesa orçamentária dos municípios, que repercutem sobre as condições locais para a garantia da estabilidade do financiamento da APS no Brasil.

El artículo tiene como objetivo analizar los efectos de la ampliación de la transferencia de recursos federal de enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud (APS) en el Sistema Único de Salud brasileño (SUS), en el período del 2015 al 2020. Se realizó un estudio longitudinal con datos secundarios de transferencias de recursos por enmiendas parlamentarias del Ministerio de Salud y de gastos con recursos propios de los municipios, aplicados a acciones y servicios públicos de salud y a la APS. El efecto de la transferencia de recursos de enmiendas parlamentarias sobre el financiamiento municipal se verificó de forma estratificada por tamaño de población de los municipios, utilizando modelos de ecuaciones de estimaciones generalizadas. La transferencia de recursos de enmiendas parlamentarias para la APS mostró una gran discrepancia en los valores per cápita entre municipios de diferente tamaño poblacional. No hubo correlación con el gasto municipal en acciones y servicios públicos de salud en aquellos con más de 10.000 habitantes y asociación inversa con el gasto en APS (p < 0,050) en todos los grupos de municipios. Se concluye que el aumento en la transferencia de recursos de enmiendas parlamentarias por parte del Ministerio de Salud favoreció la reducción de la asignación de ingresos municipales a la APS, que pueden haber sido dirigidos a otros fines de gasto en el SUS. Tales cambios parecen reflejar prioridades establecidas para el gasto presupuestario municipal, que repercuten en las condiciones locales para garantizar la estabilidad del financiamiento de la APS en Brasil.

Innovations in Public Financing for Family Planning at Subnational Levels: Sustainable Cofinancing Strategies for Family Planning With Nigerian States.

Global declines in donor funding present a substantial threat to development financing in low- and middle-income countries. In Nigeria, the resources required to achieve states' health goals surpass existing government budgets and available donor funding, a shortfall that incentivizes efforts to expand nondonor sources of financing, including public-driven cofinancing models. The Challenge Initiative (TCI) in Nigeria implements a demand-led model wherein 13 state governments requested technical support from TCI to adapt and scale up high-impact family planning and reproductive health (FP/RH) interventions. TCI provides a blend of technical coaching and financial support through the Challenge Fund, a mechanism designed to incentivize domestic funding for FP programming. To qualify as a recipient, states must demonstrate political will, financial commitment, and potential for impact at scale. However, state financial commitments alone are insufficient to guarantee the successful implementation of health scale-up initiatives. For this reason, the TCI Nigeria cofinancing strategy builds positive relations among key actors (donors, implementers, and government) and improves accountability in FP/RH financing. Although there are several donor-led cofinancing primary health care initiatives in Nigeria, such as the Saving One Million Lives Performance for Results project and Basic Healthcare Provision Fund, little is known about the role of government in driving the process specifically for improving domestic FP/RH financing. In Nigeria, state governments, in collaboration with TCI, developed a cofinancing model that helps states meet their FP/RH financing commitments. To promote effectiveness and sustainability, this model operates within an existing state structure, the State Annual Operation Plan. TCI's cofinancing model motivates continuous improvement in state governments' fiscal capacity, using a framework to measure, track, and reward financial and nonfinancial state commitments. Although the model is not a replacement for existing program tracking and monitoring tools, it helps subnational governments better harness their resources to accelerate improvement in FP/RH outcomes.

Government subsidy and benefit distribution mechanisms for transportation PPP projects: An evolutionary game perspective.

Public-private partnerships (PPP), as an important model for collaboration between the public and private sectors, is an urgent and critical topic due to the serious financial losses of governments involved in transportation PPP projects in recent years. Current research focuses on the government subsidy model, in which the effective implementation of government subsidies relies on the design of incentives for stakeholder behavior. Although the positive externalities are strong, they are prone to the problem of "free riding," which leads to low project performance and challenges in compensating for the government's financial losses. Therefore, this study proposes a novel dynamic subsidy mechanism that can be adjusted based on actual changes in transportation demand and that is linked to project performance. We use evolutionary game theory to construct a two-party evolutionary game model of the government and social capital, focusing on the stability and influencing factors of these interactions. Our research unveils that reaching specific thresholds in both the incentive coefficient and benefit distribution ratio induces an "positive management-negative management" shift in the behavior of involved parties, leading to enhanced project outcomes. Notably, fluctuations in operational quality substantially enhance the efficiency of the active management of private sector, with no discernible impact on the subsidy efficiency of the government. Therefore, our study provides a theoretical framework for improving the revenue allocation and government subsidy mechanism, which has theoretical and practical implications for enhancing the effect of government incentives and improving the quality of operational social capital.

Importance of sustainable local government funding in tackling health inequalities in the UK.

This article looks at how there is evidence that policies that alter our environment are more effective than those that work to change individual behaviour. In order to create change, a more nuanced methodology to allocate local government funding is needed.