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PUBLIC HEALTH FUNDING IN PUBLIC HEALTH FUNDING IN WISCONSINWISCONSIN

PUBLIC HEALTH COUNCILPUBLIC HEALTH COUNCILDr. Sheri Johnson, State Health OfficerDr. Sheri Johnson, State Health Officer

Wisconsin Division of Public HealthWisconsin Division of Public Health

April 13, 2007April 13, 2007

US Health Care Costs:US Health Care Costs:$2 Trillion Dollars$2 Trillion Dollars

Health Care Costs in 10 Years:Health Care Costs in 10 Years:$4 Trillion Dollars$4 Trillion Dollars

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Having a System that Lowers Costs Having a System that Lowers Costs by Helping People be Healthy:by Helping People be Healthy:

PRICELESSPRICELESS

Public Health

*Source: "Burdened by healthcare costs. US Businesses seek a shift." The Christian Science *Source: "Burdened by healthcare costs. US Businesses seek a shift." The Christian Science Monitor. February 13, 2007Monitor. February 13, 2007

*Source: 2004 Statewide Local Public Health Survey. Conducted by Division of Public Health. *Source: 2004 Statewide Local Public Health Survey. Conducted by Division of Public Health.

Statewide LPHD Expenditures by Statewide LPHD Expenditures by Source of FundsSource of Funds

Local Taxes 58%

Grants from State 17%

Fees for Service 14%

Other Categorical Funds 11%

2005-07 Wisconsin Total Budget2005-07 Wisconsin Total Budgetby State Agency by State Agency

(Total Budget = $26 billion)(Total Budget = $26 billion)

Transportation 9.49%

Corrections 4.17%

Other 19.11%Shared

Revenues 21.8%

Public Instruction

22.68%

Health & Family Svcs

23.35%

University of Wisconsin

13.93%

Workforce Development 5.1%

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2005-07 DHFS Budget by 2005-07 DHFS Budget by Expenditure Type Expenditure Type

(Total Budget = $6.07 billion)(Total Budget = $6.07 billion)

Aids to Individuals

79.63%

Local Assistance

9.49% State Operations

10.88%

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2005-07 DHFS Total Budget 2005-07 DHFS Total Budget by Division by Division

(Total Budget = $6.07 billion)(Total Budget = $6.07 billion)

Health Care Financing74.28%

Disability & Elder Services

17.54%

Children & Family

Services5%

Public Health2.42% Executive

Services1.22%

,

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Division of Public Health Division of Public Health SFY 06 by Funding Source SFY 06 by Funding Source (Total Budget = $157 Million)(Total Budget = $157 Million)

GPR 19%

Federal 73%

Program Revenue

8%

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Division of Public Health Division of Public Health Allocation of GPR FundsAllocation of GPR Funds

Municipal 15%

State Ops 18%

Intra/Inter Agency 4%

Non-Municipal

63%

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Division of Public Health Division of Public Health Allocation of Federal FundsAllocation of Federal Funds

Municipal 18%

State Ops 19%

Inter-agency 7%

Non-Municipal 56%

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Division of Public HealthDivision of Public HealthAllocation of Program Revenue & Allocation of Program Revenue &

Other FundsOther Funds

Municipal 2%

State Ops 75%

Inter Agency

5%

Non-Municipal

18%

*Bureau of Health Information and Policy added to DPH *Bureau of Health Information and Policy added to DPH **Additional $554,400 GPR for Statewide Trauma System - all $ contracted to Partners **Additional $554,400 GPR for Statewide Trauma System - all $ contracted to Partners

Division of Public Health Division of Public Health GPR Funding TrendsGPR Funding Trends

0

5

10

15

20

25

30

35

40

SFY 2003 SFY 2004 SFY 2005 SFY 2006 SFY 2007

Millio

ns

GPR Aids

DPH Internal Budget

49.45 FTE

41.58FTE

34.41 FTE

46.03FTE

45.03FTE

$ 5.3 $ 4.6 $ 4.3 $ 4.8* $5.3**

Examples of Examples of Federal Grant FundingFederal Grant Funding

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

FFY 03 FFY 04 FFY 05 FFY 06 FFY 07

HIVPrevention

PreventionBlock Grant

Comp STDPrev System

Public Health Preparedness Public Health Preparedness Grant fundingGrant funding

Public Health Preparedness Public Health Preparedness Funding 2002-07Funding 2002-07

Local & Tribal Agencies & GLITC

55.10%

Laboratory 12.60%

UW DoIT & IT 10%

DPH 15.60%

Partner Contracts 6.7%

Division of Public Health Division of Public Health Grant FundingGrant Funding

$156.2

$169.2 $171.8

$153.7

$133.5

$100

$110

$120

$130

$140

$150

$160

$170

$180

CY 2002 CY 2003 SFY 2004 SFY 2005 SFY 2006

Mill

ion

s

69 Grants

86 Grants

86 Grants

107 Grants101

Grants

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Public Health Public Health Return on InvestmentReturn on Investment

*Source: Behaviorial Risk Factor Surveillance Survey, 2005. Centers for Disease Control and P*Source: Behaviorial Risk Factor Surveillance Survey, 2005. Centers for Disease Control and Preventionrevention

Obesity Epidemic in WIObesity Epidemic in WI22%22% Adults eating at least 5 Adults eating at least 5

servings of fruits & vegetables servings of fruits & vegetables per dayper day

55%55% Adults meeting minimum Adults meeting minimum activity level  activity level 

61%61% overweight or obese overweight or obese

*Source: "An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?" *Source: "An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?" Wisconsin Public Health & Health Policy Institute. 2003Wisconsin Public Health & Health Policy Institute. 2003

Cost of Treating ObesityCost of Treating Obesity

National cost National cost = = $77 billion$77 billion per year per year

Wisconsin’s share Wisconsin’s share = = $1.4 billion$1.4 billion per year per year

*Source: "2006 Burden of Tobacco Report." American Cancer Society*Source: "2006 Burden of Tobacco Report." American Cancer Society

Tobacco Use & Tobacco Use & Secondhand SmokeSecondhand Smoke

Every year in WI, Every year in WI, over over 8,0008,000 tobacco-related tobacco-related

deathsdeaths$2.16 billion$2.16 billion in direct health in direct health

care costs care costs SignificantSignificant lost productivity lost productivity

*Source: "2006 Burden of Tobacco Report." American Cancer Society*Source: "2006 Burden of Tobacco Report." American Cancer Society

Public Health is the AnswerPublic Health is the Answer

Programs and policies to prevent Programs and policies to prevent and reduce the number of and reduce the number of people who smoke cigarettes people who smoke cigarettes and use tobacco are the most and use tobacco are the most effective way to eliminate this effective way to eliminate this burden.burden.

*Source: "America's Health Rankings 2006." United Health Foundation *Source: "America's Health Rankings 2006." United Health Foundation **Source: Journal of Health Affairs. Published online 2/21/07 **Source: Journal of Health Affairs. Published online 2/21/07

ChallengesChallenges

Public Health Spending: WI Public Health Spending: WI

lowlow per capita: per capita: $79/person*$79/person*

Health Care Costs: USA Health Care Costs: USA

highhigh per capita: per capita: $7,498/person**$7,498/person**

*Source: "America's Health Rankings 2006." United Health Foundation *Source: "America's Health Rankings 2006." United Health Foundation

Good NewsGood News

WI WI 1010thth Healthiest State Healthiest State in Nation - 2006in Nation - 2006

Improvement from 13Improvement from 13thth - - 20052005

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Governor’s Proposed Governor’s Proposed 2007-09 2007-09

Budget HighlightsBudget Highlights

BadgerCarePlus (BC+)BadgerCarePlus (BC+)

Provides access to affordable health care for all Provides access to affordable health care for all childrenchildren

In addition to all children, expands eligibility to other In addition to all children, expands eligibility to other new populations:new populations: Youth (aged 18 through 20) aging out of foster care Pregnant women from 185-300% federal poverty level

(FPL) Caretaker relatives up to 200% FPL Parents with children in foster care up to 200% FPL Farmers and other self-employed individuals up to 200%

FPL, contingent on depreciation calculations

BadgerCarePlus BadgerCarePlus (continued)(continued)

Streamlines eligibilityStreamlines eligibility Promotes prevention and healthy behaviorPromotes prevention and healthy behavior Establishes benchmark plan for majority of Establishes benchmark plan for majority of

expansion populationsexpansion populations Budget neutral: funded through greater use Budget neutral: funded through greater use

of managed care, administrative savings, and of managed care, administrative savings, and a new co-pay and premium structurea new co-pay and premium structure

Requires federal approvalRequires federal approval Target implementation date: Jan. 2008 Target implementation date: Jan. 2008

Public HealthPublic Health

Smoking Prevention and Cessation:Smoking Prevention and Cessation:

Increase tobacco tax by $1.25/pack Increase tobacco tax by $1.25/pack Additional $20 million/year funding + Additional $20 million/year funding +

current $10 million base = $30 million/year current $10 million base = $30 million/year To increase smoking prevention and To increase smoking prevention and

cessation efforts cessation efforts

Public Health Public Health (continued)(continued) MA Family Planning Waiver for MalesMA Family Planning Waiver for Males Vital Records AutomationVital Records Automation

Federally mandatedFederally mandated Vital Record Fees are increased: fee revenue Vital Record Fees are increased: fee revenue

used to fund automation, increased child abuse used to fund automation, increased child abuse and AODA prevention services, increased and AODA prevention services, increased domestic abuse services, and provide add’l domestic abuse services, and provide add’l funding to countiesfunding to counties

AIDS/HIV Program: AIDS/HIV Program: Fully funds projected caseload in Drug Assistance Fully funds projected caseload in Drug Assistance

ProgramProgram Enroll eligible individuals from AIDS Drug Enroll eligible individuals from AIDS Drug

Assistance Program to HIRSP, use savings Assistance Program to HIRSP, use savings generated to increase funding to life care servicesgenerated to increase funding to life care services

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Questions?Questions?