Date of Award

2018

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Michael Meacham

Third Advisor

Jeanne Matthews

Fourth Advisor

James S Zoller

Abstract

In response to changes in the local public health system driven by budget cuts, funding requirements, and increased costs of providing clinical and preventive services, local health departments (LHDs) are increasingly billing third party payers to generate revenue. Survey and interview data from the National Association of County and City Health Officials (NACCHO) indicate that 90% of LHDs bill third-party payers. Although systems are set up to bill public insurance such as Medicaid and Medicare, there is a paucity of information on billing commercial insurance. This study contributes to understanding the current billing landscape for local public health. A retrospective examination of private insurance data for a five-year period indicates a 123% increase in reimbursement to health departments and an 11% increase in out of pocket costs to clients. Regional variations show that clients in the Northeast paid more out of pocket compared to other U.S. regions. Additionally, reimbursements to health departments were higher in Medicaid expansion vs. non-expansion states.

Rights

All rights reserved. Copyright is held by the author.

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