HLTH 8317 Week 9 Billing Versus Earmark Analysis Example

Revenue Analysis: An Urban Health Department Expands Billing for Immunizations and Sexual Health Services, What the Revenue Brings and What It Pulls Attention Toward, Set Beside a Dedicated Tobacco Tax Earmark as the Alternative

Student Name

Walden University

HLTH 8317: Financing Public Health Systems

Instructor Name

Month Day, Year

Revenue Analysis: An Urban Health Department Expands Billing for Immunizations and Sexual Health Services, What the Revenue Brings and What It Pulls Attention Toward, Set Beside a Dedicated Tobacco Tax Earmark as the Alternative

The Change

An urban health department, put together from typical features, expanded billing for clinical services over two years. Before the change, its immunization and sexual health clinics billed only Medicaid, and only sporadically. After it, the department contracted with the major private insurers in its area, credentialed its nurses and clinicians, hired two billing specialists and a coder, and installed billing software linked to its health record. By the second year, clinical revenue had roughly doubled. The department used part of the new revenue to keep clinic hours that a funding cut would otherwise have reduced.

What Billing Brings

Billing brings money that is tied to services already provided, rises when the clinics see more insured patients and does not depend on the next grant cycle. It also brings the department into the health care system's financial structure, which can strengthen relationships with insurers and providers. For immunizations, billing insured patients for vaccine administration lets the department reserve publicly purchased vaccine and program funds for uninsured patients.

What Billing Pulls Attention Toward

Billing also changes what an agency notices. Once revenue depends on billable encounters, managers watch encounter counts, payer mix and denied claims. Clinics may begin to favor insured patients in scheduling, without any explicit policy, because insured visits sustain the budget. Staff time shifts toward documentation and coding. And some services become harder to provide in the way public health intends.

Sexual health services show this most clearly. People seeking testing or treatment for sexually transmitted infections may avoid care if they fear that an insurer's explanation of benefits will reach a parent or spouse. A department that bills private insurance for every visit risks driving away the patients its sexual health program exists to reach, unless it offers a confidential, unbilled option. Partner services and outbreak response, the population-level work that makes a sexual health program a public health program, generate no billable encounters at all.

Public Health 3.0 argues that local health departments should increasingly serve as the community's lead strategist on health, bringing many sectors together around social and environmental causes, and spend less of their effort running clinics (DeSalvo et al., 2017). Expanded billing moves in the other direction, deepening the department's investment in the clinical role. That may be the right choice where no other provider will see the uninsured, but it should be made deliberately.

The Alternative: A Dedicated Tobacco Tax Earmark

The department could instead have asked the city to dedicate a share of a local tobacco tax to public health. A tobacco tax also cuts smoking by itself, and Chaloupka et al. (2012) noted that the health payoff grows when part of the revenue goes to tobacco control and other health programs. An earmark would provide revenue not tied to individual encounters, which could support population-level work such as partner services, surveillance and community programs. It would not create pressure toward insured patients.

An earmark has its own weaknesses. Tobacco tax revenue falls as smoking declines, so a successful tax shrinks its own earmark. Legislators can redirect earmarked funds in a budget crisis. And winning an earmark requires a political campaign the department may not be able to lead.

Comparison

Billing produces revenue the department controls operationally and that grows with clinical volume, but it ties money to individual services and draws attention toward insured patients. An earmark produces revenue that can support population work, but it is politically harder to win, exposed to redirection and likely to decline over time. The Institute of Medicine committee's call for dedicated funding of foundational capabilities, separate from clinical revenue, points toward the earmark's logic (Institute of Medicine, 2012).

Conclusion

The analysis does not conclude that billing harms public health departments. It concludes that billing should be adopted with safeguards: a confidential, unbilled option for sexual health services, a policy that scheduling does not depend on insurance status and reporting that tracks population work alongside encounters. And it suggests that the department should still pursue dedicated, non-clinical revenue for the work billing cannot pay for.

References

Chaloupka, F. J., Yurekli, A., & Fong, G. T. (2012). Tobacco taxes as a tobacco control strategy. Tobacco Control, 21(2), 172-180. https://doi.org/10.1136/tobaccocontrol-2011-050417

DeSalvo, K. B., Wang, Y. C., Harris, A., Auerbach, J., Koo, D., & O'Carroll, P. (2017). Public health 3.0: A call to action for public health to meet the challenges of the 21st century. Preventing Chronic Disease, 14, Article E78. https://doi.org/10.5888/pcd14.170017

Institute of Medicine. (2012). For the public's health: Investing in a healthier future. The National Academies Press. https://doi.org/10.17226/13268