Transformations in Public Health Systems

Health Affairs

Volumn 17, Issue 3, 1998, Pages 64-80

  Wall, Susan ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE COST; HEALTH INSURANCE; HUMAN; MEDICAID; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PUBLIC HEALTH SERVICE; PUBLIC RELATIONS; UNITED STATES;

FINANCING, GOVERNMENT; HEALTH EXPENDITURES; HUMANS; INTERINSTITUTIONAL RELATIONS; MANAGED CARE PROGRAMS; MEDICAID; ORGANIZATIONAL INNOVATION; PRIVATIZATION; PUBLIC HEALTH ADMINISTRATION; STATE GOVERNMENT; UNITED STATES;

EID: 0032060411     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.3.64     Document Type: Article

References (22)

1. P. Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982).
2. M. Terris and N. Kramer, "Medical Care Activities of Full-Time Health Departments," American Journal of Public Health 39, no. 9 (1949): 1125-1129.
3. E.L. Baker et al., "Health Reform and the Health of the Public: Forging Community Health Partnerships," Journal of the American Medical Association 272, no. 16 (1994): 1276-1282; and P.R. Lee, "Reinventing Public Health," Journal of the American Medical Association 270, no. 22 (1993): 2670.
4. E.L. Baker et al., "Health Reform and the Health of the Public: Forging Community Health Partnerships," Journal of the American Medical Association 272, no. 16 (1994): 1276-1282; and P.R. Lee, "Reinventing Public Health," Journal of the American Medical Association 270, no. 22 (1993): 2670.
5. For state selection criteria and details of the ANF project, see A. Kondratas, A. Weil, and N. Goldstein, "Assessing the New Federalism: An Introduction," in this volume of Health Affairs.
6. Institute of Medicine, The Future of Public Health (Washington: National Academy Press, 1988).
7. U.S. Public Health Service, For a Healthy Nation: Returns on Investment in Public Health (Rockville, Md.: PHS, 1994); and U.S. Centers for Disease Control and Prevention, Core Functions of Public Health (Atlanta: CDC, 1991).
8. U.S. Public Health Service, For a Healthy Nation: Returns on Investment in Public Health (Rockville, Md.: PHS, 1994); and U.S. Centers for Disease Control and Prevention, Core Functions of Public Health (Atlanta: CDC, 1991).
9. National Association of County and City Health Officials, 1992-1993 National Profile of Local Health Departments (Washington: NACCHO, 1995); and A.N. Koplin, "The Future of Public Health: A Local Health Department View," Journal of Public Health Policy 11, no. 4 (1990): 420-437.
10. National Association of County and City Health Officials, 1992-1993 National Profile of Local Health Departments (Washington: NACCHO, 1995); and A.N. Koplin, "The Future of Public Health: A Local Health Department View," Journal of Public Health Policy 11, no. 4 (1990): 420-437.
11. Unless otherwise noted, sources for the information for the sections that follow are case-study interviews conducted in the thirteen states.
12. Public Health Practice Program Office, Profile of State and Territorial Public Health Systems: United States, 1990 (Atlanta: CDC, December 1991).
13. This estimate is based on a study of eight states' spending. See Public Health Foundation, "Measuring State Expenditures for Core Public Health Functions," Research and Measurement in Public Health Practice, a supplement to the American Journal of Preventive Medicine 11, no. 6 (1995): 58-73.
14. Alabama is the only state whose public health system is controlled by the medical society; the medical society appoints the state health officer, who serves at its pleasure rather than at that of the governor.
15. L. Whitehand et al., Privatization and Public Health: A Study of Initiatives and Early Lessons Learned (Washington: Public Health Foundation, 1 August 1997).
16. Ibid.
17. Center for Studying Health System Change, Tracking Changes in the Public Health System, Issue Brief (Washington: CSHSC, 1996).
18. A study of nine states found that 44 percent of local health department dollars were spent on personal health services, such as MCH and primary care. See K.W. Eilbert et al., Measuring Expenditures for Essential Public Health Services (Washington: Public Health Foundation, November 1996).
19. The reconfiguration of services occurred primarily to maximize Medicaid revenues under Los Angeles's Section 1115 waiver program.
20. From the perspective of most state-level agencies, however, there appears to be less concern about funding, as discussed earlier.
21. According to one source, local health departments served as contractors or subcontractors for Medicaid managed care programs in twenty-five states in 1996 - an increase from fourteen states in 1994. The number of health departments participating in each state is unknown but appears to be small. See J. Horvath et al., Medicaid Managed Care: A Guide for the States, 3d ed., vol. 1, part 1 (Portland, Maine: National Academy for State Health Policy, January 1997).
22. IOM, The Future of Public Health.