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Peter J. Neumann, ScD, Peter D. Jacobson, JD and Jennifer A. Palmer, MS

Peter J. Neumann and Jennifer A. Palmer are with the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, Boston, MA. Peter J. Neumann is also with the Tufts University School of Medicine, Boston. Peter D. Jacobson is with the School of Public Health, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Peter Neumann, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111 (e-mail: pneumann{at}tuftsmedicalcenter.org).

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.

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