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McCullough JM. Timing of Clinical Billing Reimbursement for a Local Health Department. Public Health Rep 2016; 131:283-9. [PMID: 26957663 DOI: 10.1177/003335491613100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. METHODS Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. RESULTS Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. CONCLUSIONS Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.
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Affiliation(s)
- J Mac McCullough
- Arizona State University, School for the Science of Health Care Delivery, Phoenix, AZ; Maricopa County Department of Public Health, Phoenix, AZ
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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Jadhav ED, Holsinger JW, Fardo DW. Openness to Change: Experiential and Demographic Components of Change in Local Health Department Leaders. Front Public Health 2015; 3:209. [PMID: 26389108 PMCID: PMC4554942 DOI: 10.3389/fpubh.2015.00209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022] Open
Abstract
Background During the 2008–2010 economic recession, Kentucky local health department (LHD) leaders utilized innovative strategies to maintain their programs. A characteristic of innovative strategy is leader openness to change. Leader demographical research in for-profit organizations has yielded valuable insight into leader openness to change. For LHD leaders, the nature of the association between leader demographic and organizational characteristics on leader openness to change is unknown. The objectives of this study are to identify variation in openness to change by leaders’ demographic and organizational characteristics and to characterize the underlying relationships. Materials and Methods The study utilized Spearman rank correlations test to determine relationships between leader openness to change (ACQ) and leader and LHD characteristics. To identify differences in the distribution of ACQ scores, Wilcoxon–Mann–Whitney and Kruskal–Wallis non-parametric tests were used, and to adjust for potential confounding, linear regression analysis was performed. Data Local health department leaders in the Commonwealth of Kentucky were the unit of analysis. Expenditure and revenue data were available from the state health department. National census data were utilized for county level population estimates. A cross-sectional survey was performed of KY LHD leaders’ observable attributes relating to age, gender, race, educational background, leadership experience, and openness to change. Results Leaders had relatively high openness to change scores. Spearman correlations between leader ACQ and departmental 2012–2013 revenue and expenditures were statistically significant, as were the differences observed in ACQ by gender and the educational level of the leader. Differences in ACQ score by education level and agency revenue were significant even after adjusting for potential confounders. The analyses imply that there are underlying relationships between leader and LHD characteristics based on leader openness to change.
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Affiliation(s)
- Emmanuel D Jadhav
- Public Health Programs, Ferris State University , Big Rapids, MI , USA
| | - James W Holsinger
- Department of Preventive Medicine, University of Kentucky , Lexington, KY , USA
| | - David W Fardo
- Department of Biostatistics, University of Kentucky , Lexington, KY , USA
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Luo H, Sotnikov S, Winterbauer N. Provision of Personal Healthcare Services by Local Health Departments: 2008-2013. Am J Prev Med 2015; 49:380-6. [PMID: 25997902 PMCID: PMC4831056 DOI: 10.1016/j.amepre.2015.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008-2013 and examine the association between provision of personal healthcare services and per capita public health expenditures. METHODS Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014. RESULTS The mean number of personal healthcare services provided by LHDs did not change significantly in 2008-2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services' share of revenue and per capita expenditures (b=0.57, p<0.001). CONCLUSIONS A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
| | - Sergey Sotnikov
- Office for State, Tribal, Local and Territorial Support, CDC, Atlanta, Georgia
| | - Nancy Winterbauer
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Variation in Local Health Department Primary Care Services as a Function of Health Center Availability. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21:E1-9. [DOI: 10.1097/phh.0000000000000112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Targeted health department expenditures benefit birth outcomes at the county level. Am J Prev Med 2014; 46:569-77. [PMID: 24842733 PMCID: PMC4082983 DOI: 10.1016/j.amepre.2014.01.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/17/2014] [Accepted: 01/30/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. PURPOSE This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. METHODS A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. RESULTS Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects. CONCLUSIONS Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.
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Luo H, Sotnikov S, Shah G. Local health department activities to ensure access to care. Am J Prev Med 2013; 45:720-7. [PMID: 24237913 PMCID: PMC4831054 DOI: 10.1016/j.amepre.2013.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/29/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Local health departments (LHDs) can play an important role in linking people to personal health services and ensuring the provision of health care when it is otherwise unavailable. However, the extent to which LHDs are involved in ensuring access to health care in its jurisdictions is not well known. PURPOSE To provide nationally representative estimates of LHD involvement in specific activities to ensure access to healthcare services and to assess their association with macro-environment/community and LHD capacity and process characteristics. METHODS Data used were from the 2010 National Profile of Local Health Departments Study, Area Resource Files, and the Association of State and Territorial Health Officials' 2010 Profile of State Public Health Agencies Survey. Data were analyzed in 2012. RESULTS Approximately 66.0% of LHDs conducted activities to ensure access to medical care, 45.9% to dental care, and 32.0% to behavioral health care. About 28% of LHDs had not conducted activities to ensure access to health care in their jurisdictions in 2010. LHDs with higher per capita expenditures and larger jurisdiction population sizes were more likely to provide access to care services (p <0.05). CONCLUSIONS There is substantial variation in LHD engagement in activities to ensure access to care. Differences in LHD capacity and the needs of the communities in which they are located may account for this variation. Further research is needed to determine whether this variation is associated with adverse population health outcomes.
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Affiliation(s)
- Huabin Luo
- Office for State, Tribal, Local and Territorial Support, CDC, Atlanta.
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Hsuan C, Rodriguez HP. The adoption and discontinuation of clinical services by local health departments. Am J Public Health 2013; 104:124-33. [PMID: 24228663 DOI: 10.2105/ajph.2013.301426] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We identified factors associated with local health department (LHD) adoption and discontinuation of clinical services. METHODS We used multivariate regression with 1997 and 2008 LHD survey and area resource data to examine factors associated with LHDs maintaining or offering more clinical services (adopter) versus offering fewer services (discontinuer) over time and with the number of clinical services discontinued among discontinuers. RESULTS Few LHDs (22.2%) were adopters. The LHDs were more likely to be adopters if operating in jurisdictions with local boards of health and not in health professional shortage areas, and if experiencing larger percentage increase in non-White population and Medicaid managed care penetration. Discontinuer LHDs eliminated more clinical services in jurisdictions that decreased core public health activities' scope over time, increased community partners' involvement in these activities, had larger increases in Medicaid managed care penetration, and had lower LHD expenditures per capita over time. CONCLUSIONS Most LHDs are discontinuing clinical services over time. Those that cover a wide range of core public health functions are less likely to discontinue services when residents lack care access. Thus, the impact of discontinuation on population health may be mitigated.
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Affiliation(s)
- Charleen Hsuan
- Both authors are with the Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles
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Local health department assurance of services and the health of California's seniors. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:550-61. [PMID: 23838898 DOI: 10.1097/phh.0b013e31828e25e5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING Fifty-seven California counties. PARTICIPANTS 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.
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Tynkkynen LK, Keskimäki I, Lehto J. Purchaser-provider splits in health care-the case of Finland. Health Policy 2013; 111:221-5. [PMID: 23790264 DOI: 10.1016/j.healthpol.2013.05.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
The purchaser-provider split (PPS) is a service delivery model in which third-party payers are kept organizationally separate from service providers. The operations of the providers are managed by contracts. One of the main aims of PPS is to create competition between providers. Competition and other incentive structures built into the contractual relationship are believed to lead to improvements in service delivery, such as improved cost containment, greater efficiency, organizational flexibility, better quality and improved responsiveness of services to patient needs. PPS was launched in Finland in the early 1990s but was not widely implemented until the early 2000s. Compared to other countries with PPS the development and implementation of PPS in Finland has been unusual. Firstly, purchasing is implemented at the level of municipalities, which means that the size of the Finnish purchasers is extremely small. Elsewhere purchasing is mostly implemented at the regional or national levels. Secondly, PPS is also applied to primary health care and A&E services while in other countries the services mainly include specialized health care and residential care for the elderly. Thirdly, PPS in health and social services is not regulated by any specific legislation, regulative mechanisms or guidelines. Instead it is regulated within the same framework as public procurement in general.
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Affiliation(s)
- Liina-Kaisa Tynkkynen
- University of Tampere, School of Health Sciences, School of Health Sciences FI-33014 University of Tampere, Finland.
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Tynkkynen LK, Lehto J, Miettinen S. Framing the decision to contract out elderly care and primary health care services - perspectives of local level politicians and civil servants in Finland. BMC Health Serv Res 2012; 12:201. [PMID: 22805167 PMCID: PMC3411497 DOI: 10.1186/1472-6963-12-201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/17/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. METHODS Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. RESULTS Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. CONCLUSIONS This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.
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Affiliation(s)
| | - Juhani Lehto
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Sari Miettinen
- School of Health Sciences, University of Tampere, Tampere, Finland
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Leadership matters: local health department clinician leaders and their relationship to decreasing health disparities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 18:E1-E10. [PMID: 22286291 DOI: 10.1097/phh.0b013e318242d4fc] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The activities that local health departments (LHDs) conduct and their workforce characteristics change over time. We know little, however, about how changes among the services LHDs conduct are associated with the nature of LHD leadership and how these factors impact health. This study investigated changes in LHD services and leadership and how these changes are associated with mortality disparities. DESIGN We conducted regression analyses of secondary data using an exploratory panel time series design. MEASURES We used secondary data to investigate changes in LHD services and leadership and how these changes were associated with each other and with 1993 to 2005 changes in black-white mortality disparities. Local health department services were examined relative to change in breadth of services within each of 10 program domains between 1993 and 2005. LHD leadership was examined for discipline of the lead executive in 1993 and 2005. STUDY POPULATION Our sample included 558 county or multicounty "common local areas," representing county-level data for LHDs and their jurisdictions. RESULTS Significant beneficial relationships exist between having a clinician as lead executive in an LHD and reductions in black-white mortality disparities. Local health departments with a clinician (usually a nurse or physician) as their lead executive in 1993 and/or 2005 experienced a significant decrease in black-white mortality disparities for young adults (age 15-44 years) in their jurisdictions from 1993 to 2005 when compared with LHDs with nonclinician leaders. CONCLUSIONS The discipline of an LHD's lead executive as a clinician appears to have a significant relationship with the impact of LHD practice on reducing black-white mortality disparities. This study suggests that the discipline of an LHD's leadership may be an important factor to consider in relation to local public health capacity to impact health disparities. Further research related to the mechanisms at play in these relationships is warranted.
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Beatty K, Harris JK, Barnes PA. The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments. J Rural Health 2010; 26:248-58. [DOI: 10.1111/j.1748-0361.2010.00285.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Laamanen R, Simonsen-Rehn N, Suominen S, Øvretveit J, Brommels M. Outsourcing primary health care services—How politicians explain the grounds for their decisions. Health Policy 2008; 88:294-307. [PMID: 18501465 DOI: 10.1016/j.healthpol.2008.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 04/03/2008] [Accepted: 04/05/2008] [Indexed: 10/22/2022]
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Gollust SE, Jacobson PD. Privatization of public services: organizational reform efforts in public education and public health. Am J Public Health 2006; 96:1733-9. [PMID: 17008563 PMCID: PMC1586133 DOI: 10.2105/ajph.2005.068007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2005] [Indexed: 11/04/2022]
Abstract
The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health.
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Affiliation(s)
- Sarah E Gollust
- Department of Health Management and Policy at the University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA
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Jacobson PD, Dalton VK, Berson-Grand J, Weisman CS. Survival strategies for Michigan's health care safety net providers. Health Serv Res 2005; 40:923-40. [PMID: 15960698 PMCID: PMC1361175 DOI: 10.1111/j.1475-6773.2005.00392.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. DATA SOURCES/STUDY SETTING Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. RESEARCH DESIGN In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. PRINCIPAL FINDINGS Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. CONCLUSIONS Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity.
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Affiliation(s)
- Peter D Jacobson
- University of Michigan School of Public Health 109 Observatory, Ann Arbor, MI 48109-2029, USA
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Keane C. The effects of managerial beliefs on service: privatization and discontinuation in local health departments. Health Care Manage Rev 2005; 30:52-61. [PMID: 15773254 DOI: 10.1097/00004010-200501000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examines the influence of Local Health Department (LHD) directors' managerial beliefs on the decision to privatize or discontinue personal health services. A stratified representative national sample of LHD directors was interviewed by telephone. Directors who believed temporary workers should be used wherever possible had about three times the odds of privatizing one or more personal health services. Directors who believed their department should focus exclusively on the core functions had more than ten times the odds of discontinuing at least one service. Declining revenue was not predictive of either privatization or discontinuation of personal health services.
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Affiliation(s)
- Christopher Keane
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA.
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Niskar AS, Buchanan S, Meyer PA. A federal agency's role in fulfilling the public health core functions: the childhood lead poisoning prevention program model. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2005; 11:50-8. [PMID: 15692293 DOI: 10.1097/00124784-200501000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Institute of Medicine identified 3 core functions of public health: assessment, policy development, and assurance. Federal, state, and local public health agencies all have an obligation to provide these vital functions to ensure conditions in which people can be healthy. However, the few publications that provide core function applications only focus on applications at the local or state levels. The Centers for Disease Control and Prevention's Childhood Lead Poisoning Prevention Program uses a comprehensive public health approach. This article describes the Centers for Disease Control and Prevention's leading role in applying the core public health functions to prevent childhood lead poisoning.
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Affiliation(s)
- Amanda Sue Niskar
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lazzarini Z, Elman D. Legal options for achieving public health outcomes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 8:65-75. [PMID: 15156649 DOI: 10.1097/00124784-200209000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To achieve desired public health outcomes, state agencies can choose among several legal mechanisms; however, no "best practice" guidelines are available to help them choose the most effective mechanism for a given situation. This article offers such guidance by comparing the relative advantages and disadvantages of laws, regulations, policies, and contracts. Factors compared include flexibility, the need for legislative involvement, the nature of the rulemaking process, enforceability, ability to reach target populations, and generalizability. Contracts, in particular, are described as an effective but underutilized mechanism for achieving successful public health outcomes.
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Affiliation(s)
- Zita Lazzarini
- Program in Medical Humanities, Health Law, and Ethics, University of Connecticut Health Center, 263 Farmington Avenue, MC-6325, Farmington, CT 06030-6325, USA.
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21
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Browning P, von Cube A, Leibrand H. Minimum Public Health Standards as a Basis for Secure Public Health Funding. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2004; 10:19-22. [PMID: 15018336 DOI: 10.1097/00124784-200401000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Peter Browning
- Skagit County Health Department, Mt. Vernon, Washington 98273, USA
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22
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Keane C, Marx J, Ricci E. Services privatized in local health departments: a national survey of practices and perspectives. Am J Public Health 2002; 92:1250-4. [PMID: 12144979 PMCID: PMC1447225 DOI: 10.2105/ajph.92.8.1250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Christopher Keane
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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23
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Keane C, Marx J, Ricci E, Barron G. The perceived impact of privatization on local health departments. Am J Public Health 2002; 92:1178-80. [PMID: 12084705 PMCID: PMC1447211 DOI: 10.2105/ajph.92.7.1178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This article presents nationally representative data on the effects of privatization on local health departments (LHDs). METHODS A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors. RESULTS One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services. CONCLUSIONS Privatization is part of a broader shift toward "managing" rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services.
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Affiliation(s)
- Christopher Keane
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Keane C, Marx J, Ricci E. The privatization of environmental health services: a national survey of practices and perspectives in local health departments. Public Health Rep 2002. [DOI: 10.1016/s0033-3549(04)50109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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