5. HRSA should commission a systematic management review focusing on organizational determinants of cost, quality, and staffing of poison control centers as the foundation for the future funding of this program. This analysis should include the following elements:
The development of new indicators of quality and impact of poison control center services.
The implications of different organizational structures and funding accountabilities on service quality and impact.
The role of center size and governance in poison control center service quality and impact.
The impact of regional differences on poison control center operational cost.
How staffing patterns, recruitment, and retention of poison control center staff affect cost, quality, and impact of poison control centers.
An economic evaluation of poison control centers to determine whether economies of scale exist among them.
As noted in Chapter 6, poison control centers are currently funded by a patchwork of sources (including federal, state, institutional, and private) that are subject to budget cuts and changing priorities every year. Across the states there are 29 separate funding sources: 6 percent of total poison control center funding comes from federal and state Medicaid programs, 3 percent from federal block grants, and 8 percent from other federal programs, for a total of 17 percent from federally associated programs. Approximately 44 percent of total funding comes from states, with many different approaches to state funding, ranging from line-item appropriation to state-funded universities to telephone surcharges. Hospitals represent 15 percent of total funding (either as host institutions or network members), another 3 percent of funding comes from a wide range of donations and grant sources, and 20 percent comes from myriad other sources.
Because of the lack of consistent, reliable funding sources, poison control centers report that significant time is spent in raising revenues and that there has been substantial instability in funding. As financial pressures on state governments and health systems have risen, the willingness of traditional funders to continue to provide revenues has dimin-