Financing, Implementation & Policy Models

The Internal Revenue Code generally does not refer to race or ethnicity, but federal income taxes may contribute to racial disparities when factors that affect tax liabilities are associated with race. Historically, it has been difficult to assess those effects because of the absence of data linking tax liabilities to race and ethnicity.

Local governments are often innovators of public health policymaking, and local control over public health issues that are vital to addressing social inequities. But states are increasingly preempting, or prohibiting, local control over public health issues. In a new paper, Jennifer Pomeranz and Diana Silver of the New York University School of Global Public Health, systematically identified strategies to pass, obscure, or enhance preemption in five policy areas.

Paula Lantz and Samantha Iovan of the University of Michigan Research Hub used their innovative pay-for-success (PFS) surveillance system to identify strengths and challenges of several supportive housing interventions using PFS, and to assess whether PFS housing projects generally meet established criteria for improving social welfare.

Steven H. Goldberg, Paula M. Lantz, and Samantha Iovan from the University of Michigan P4A Research Hub examine the use of federal Medicaid dollars as a payout source for non-medical services aimed at addressing social determinants of health under the 2016 Medicaid Managed Care Final Rule.

The Pay for Success model may prove to be a valuable tool for increasing critical investments in effective health and wellness interventions. The public-private nature of the approach can encourage important ties between the business community, investment groups, philanthropy, and public agencies and service systems; and stimulate innovative changes in the financing and delivery of sustainable, community-driven solutions.

What kind of cost savings could be achieved if a "Pay for Success" (PFS) financing model were applied to a home-based, multi-component asthma intervention among low-income children on Medicaid in Detroit? The University of Michigan Research Hub team found that the economics of a PFS intervention are most viable if it targets children who have already experienced an expensive episode of asthma-related care.

The University of Michigan Research Hub conducted 65 semi-structured interviews with state and local officials in five states where "Health in All Policies" initiatives were underway, with a goal of examining whether and how policymakers and advocates use the framework to elevate health equity as a policy concern across sectors and jurisdictions.

Public health practitioners and tobacco control advocates agree that pre-emption (a higher level of government stripping lower levels of government of their authority over a specific subject matter) has an adverse impact on tobacco control efforts. Pre-emptive state laws may prohibit local tobacco control measures, such as restrictions on marketing and promotion of tobacco products, licensure of tobacco products, smoking in public or private sites, and on youth access to tobacco products.

State pre-emption is an emerging and highly contentious policy movement with potentially significant consequences on population health. Yet robust analyses to examine whether pre-emption affects health have yet to be conducted. Furthermore, pre-emption’s effect on geographic inequities in health has been largely neglected in policy debates. But it is becoming increasingly clear that state pre-emption laws could reshape the spatial distribution of health, with profound consequences for health care delivery systems and state and local budgets.

Local governments are often on the forefront of enacting innovative public health policy, and local control over public health issues is especially vital to address social inequities. Pre-emption removes the ability of local governments to enact these laws and may hinder public health policy adoption and diffusion within a state and across the country.

Municipal laws and policies affect the social, economic, and legal conditions of civic and private lives of immigrants in profound ways, including both direct access to health services, as well as broader social determinants, such as employment, housing, education, transportation, and law enforcement.

“Pay for Success” is a public/private partnership approach to financing proven prevention interventions that help the public sector save money or achieve greater value for an investment. This project will explore the potential for and best practices by which Pay for Success initiatives (also known as social impact bonds) can address the social determinants of health and reduce public expenditures on health/social services.