摘要：We investigated ways of defining and measuring the value of services provided by governmental public health systems. Our data sources included literature syntheses and qualitative interviews of public health professionals. Our examination of the health economic literature revealed growing attempts to measure value of public health services explicitly, but few studies have addressed systems or infrastructure. Interview responses demonstrated no consensus on metrics and no connection to the academic literature. Key challenges for practitioners include developing rigorous, data-driven methods and skilled staff; being politically willing to base allocation decisions on economic evaluation; and developing metrics to capture “intangibles” (e.g., social justice and reassurance value). Academic researchers evaluating the economics of public health investments should increase focus on the working needs of public health professionals. The value of governmental public health systems may seem obvious in light of progress in public health over the past century. The reality of chronic underfunding of these systems suggests that the general public is unaware of public health's value. It is thus essential that governmental public health systems demonstrate measurable contributions to improving the population's health. On a conceptual and practical level, however, measuring the payback from public health spending is a challenge. As public health officials battle for resources in constrained fiscal environments, the manner in which they measure and communicate the value of programs—both internally in budget discussions and externally to the public—is critical. We examined how researchers and public health practitioners have defined and measured the value of services provided by governmental public health systems. First, we discuss the health economics literature on value measurement in public health. Next, we present the results of qualitative interviews we conducted with leading public health officials and practitioners. Finally, we examine ways to bridge the gap between economists and practitioners and discuss opportunities for the future.
