ARE WE GETTING THE JOB DONE? TEACHING FINANCIAL COMPETENCIES FOR PUBLIC HEALTH Louis C. Gapenski, PhD Michael E. Morris, MPH, MPA, CPH Peggy A. Honoré, DHA This research was supported by a grant from the Robert Wood Johnson Foundation 1

AGENDA Research Context Research Findings o Introduction, purpose, and approach o Setting and workforce o Finance competencies o Current finance content  Amount  Topics o Unique content requirement o Recommendations Panelist Response Audience Response Conclusion 2

RESEARCH CONTEXT Today’s presentation is one part of an effort funded by RWJ to advance the practice of finance within the field of public health. Systems thinking perspective applied. Overall effort has four main thrusts: o Improve strategic thinking and analysis o Increase relationship building o Improve public health systems organization o Increase attention to new knowledge 3

RESEARCH CONTEXT The portion of the overall effort most relevant to the research presented today includes: o Public Health Finance Institute o Public health finance website o Ratio analysis methodologies o Ratio analysis benchmarks o Sustainability (risk) index development o Redesign of public health finance courses o Development of finance teaching materials 4

INTRODUCTION Public health finance is defined as “acquiring, managing, and utilizing scarce resources to improve the health of populations.” As the scarcity of financial resources increases, the role of finance increases in importance. Evidence indicates that management as a whole is lacking in finance skills and tools. Academic institutions have a significant opportunity to contribute to workforce finance competency. 5

PURPOSE The purpose of our research is to: o Assess the adequacy of current finance education in public health (primarily MPH) programs. o Make recommendations for change. Note that academic programs address long-term knowledge needs and must be in concert with: o Continuing professional development o On-the-job training 6

APPROACH Identify the finance competencies required by public health managers. Review current educational program content. Ask this question: Does current content provide the KSAs necessary to meet the required competencies? If not, what should be done? 7

SETTING AND WORKFORCE Public health services are provided at the: o National level. o State level. o Local level. Finance activities are carried out by both finance specialists and generalist managers. Most generalist managers are not trained in management but are professionals from other fields who have managerial responsibilities. Thus, finance education must span many disciplines and be broad in scope. 8

FINANCE COMPETENCIES Over the past 20 years several studies have been made to identify public health finance competencies. The most recent (and comprehensive) work was published last year by Honoré and Costich. o Three domains  Financial management, analysis, and assessment  Organizational and program planning and policy development  Administrative and general skills o Most relevant domain for finance education is the first one. o Competencies are listed for each domain. 9

CURRENT FINANCE CONTENT - AMOUNT In 2008, there were: o 22,500 students in College of Public Health MPH programs. o Of these, 3,285 (14.6%) were in management related concentrations. The goals of MPH programs are most similar to MHA and MPA programs. To judge the adequacy of the amount of content, the finance requirements of the top 20 programs in these three fields were compared. 10

CURRENT FINANCE CONTENT - AMOUNT 11

CURRENT FINANCE CONTENT – TOPICS Review of the syllabi of the top 20 MPH programs indicates that current offerings overwhelmingly reflect traditional MHA content. Thus, in general, MPH finance courses lack material related to: o Public sector organizations. o Finance functions unique to public health. 12

CURRENT FINANCE CONTENT – TOPICS Course content was compared to the identified finance competencies. Many weaknesses exist. o Some at the competency level. o But more at the knowledge, skills, and abilities (KSA) level. For example, syllabus might include ratio analysis, but MHA- oriented courses typically focus on financial and operating ratios relevant to private sector organizations (often not-for- profit hospitals). 13

CURRENT FINANCE CONTENT – TOPICS Competency differences include: o Grant acquisition and management o Disaster budgeting o Integrating budgeting with strategic and financial planning o Competencies that relate finance to the perspective and context of public health 14

CURRENT FINANCE CONTENT – TOPICS KSA differences, which mostly reflect differences between public and private sector management, include: o Financial statement format and interpretation o Ratio analysis o Budgeting o Capital financing o Capital budgeting (program) analysis 15

UNIQUE CONTENT REQUIREMENT Our review indicates that current public health finance courses do not provide: o All students with a basic understanding of finance principles. o Management concentration students with content that sufficiently reflects the uniqueness of public health. Findings supported by work at St. Louis University o Matched public health competencies against current (MHA) course competencies. o Found that only 63% of the public health competencies were covered in the course. 16

RECOMMENDATIONS All public health students, regardless of concentration, should take at least one finance course. o Introductory in nature o Should include both accounting and financial management All public health management students should take at least two finance courses. o The introductory course o A second course that focuses on application Both courses must be dedicated to public health finance. 17

PANELIST RESPONSE Comments From the Panelists 18

AUDIENCE RESPONSE Comments From the Audience 19

CONCLUSION Our thanks to the panelists and audience for your thoughtful comments! 20