Relationships Among Providing Maternal, Child, and Adolescent Health Services; Implementing Various Financial Strategy Responses; and Performance of Local Health Departments

摘要

Objectives. We explored the relationships between local health department (LHD) structure, capacity, and macro-context variables and performance of essential public health services (EPHS). Methods . In 2012, we assessed a stratified, random sample of 195 LHDs that provided data via an online survey regarding performance of EPHS, the services provided or contracted out, the financial strategies used in response to budgetary pressures, and the extent of collaborations. We performed weighted analyses that included analysis of variance, pairwise correlations by jurisdiction population size, and linear regressions. Results . On average, LHDs provided approximately 13 (36%) of 35 possible services either directly or by contract. Rather than cut services or externally consolidating, LHDs took steps to generate more revenue and maximize capacity. Higher LHD performance of EPHS was significantly associated with delivering more services, initiating more financial strategies, and engaging in collaboration, after adjusting for the effects of the Affordable Care Act and jurisdiction size. Conclusions . During changing economic and health care environments, we found that strong structural capacity enhanced local health department EPHS performance for maternal, child, and adolescent health. The recent recession and changing health care environment both present local health departments (LHDs) with opportunities and challenges. The challenges stem from reduced state payments for services, the concurrent diminished tax base for county and state general revenue, and a potential change in the LHD role because of system realignments in a health care reform environment. At the same time, a variety of opportunities exist for LHDs to address these challenges, including changing their delivery of services (e.g., eliminating or contracting), enacting a variety of financial responses to cutbacks, and collaborating with partners to ensure delivery of services or program activity. All of these changes might affect performance of the 10 essential public health services (EPHS). Little is known about the relationships among the delivery of maternal, child, and adolescent health (MCAH) programs and services, the financial strategies used by LHDs to respond to external forces and LHD collaborations, and the performance of the EPHS. We sought to understand the correlates of LHD performance in a climate of economic instability and a changing health care environment, with a particular focus on service delivery, financial strategies, and collaborations to provide information important for organizational strategic decision-making by LHDs.