The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71835

Glen P. Mays, PhD, MPH¹, Paul Halverson, DrPH², Megan C. McHugh, MPP¹, Kyumin Shim, PhD³, Natalie Perry, DrPH³, Dennis D Lenaway, MPH, PhD³, Sergey Sotnikov, PhD³, and Ramal Moonesinghe³. (1) Mathematica Policy Research, 600 Maryland Avenue SW, Suite 550, Washington, DC 20024, 202-484-4236, gmays@mathematica-mpr.com, (2) Public Health Practice Program Office, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-39, Atlanta, GA 30341-3724, (3) Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, 2877 Brandywine Road, MS K-39, Atlanta, GA 30341

OBJECTIVES: Prior studies have suggested that small public health systems with limited human and financial resources exhibit a diminished ability to perform essential public health services. This study examines the question of whether improved performance can be achieved through consolidation of local public health systems. METHODS: We use data from local public health systems in seven states that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 (n=315). We link NPHPSP performance measures with secondary data on local public health characteristics and community resources. We use multivariate econometric models to estimate how system size, financial, and workforce characteristics affect the performance of essential services, and then use these estimates to simulate the effects of consolidating neighboring public health systems. KEY FINDINGS: Multivariate estimates confirm that, for some essential services, performance is significantly related to population size and local public health spending per capita after controlling for other characteristics. When these estimates are used to simulate the effects of system consolidation, we find that performance improves significantly for some services when small jurisdictions (<50,000 population) are consolidated, but that these improvements diminish for larger jurisdictions. CONCLUSIONS: Our results suggest that, in many cases, consolidation of all public health services may not be necessary to achieve performance improvements. Consequently, administrators may wish to consider strategies for selective consolidation through contracts, service alliances and joint ventures.

Learning Objectives:

Attendees will be able to (
• understand the possible benefits and risks of public health system consolidation; (
• identify the types of services and types of systems most likely to benefit from consolidation; and (
• formulate strategies for implementing consolidation in ways that improve performance.

Keywords: Public Health Administration, Organizational Change

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.