Local health departments' performance of improving access to health care services

Background: The three core functions of public health include assessment, assurance, and policy development. As the backbone of local public health system, local health departments (LHDs) play an important role in the protection of population health. Objectives: To assess the performance of LHDs in improving access to health care services and to determine the associated factors. Methods: We used data from the 2010 National Profile of LHD Study (Profile Study). In the 2010 Profile Study, a core questionnaire was sent to all LHDs and two separate module questionnaires were sent to selected samples. 516 LHDs completed the Module 2 questionnaire, where LHDs were asked whether they conducted four programs to improve access to care, including medical, dental, and behavioral/mental care: assessing the gaps, addressing the gaps through direct provision of clinical services, increasing accessibility of existing services, and targeting health care needs of under-served population. We assessed the performance of LHDs in undertaking the four programs to improve access to care and the factors associated with conducting these programs. To account for survey design, we used svy routines in Stata 11 for data analyses. Results: Overall, 63% (95% CI: 59-68%) of LHDs were assessing the gaps; 46% (95% CI: 42-51%) were addressing the gaps; 65% (95% CI: 60-69%) were increasing service accessibility, and 64% (95% CI: 60-69%) were implementing strategies to target needs of under-served populations. Logistic regression results show that LHDs with larger jurisdiction population size, and with local- and shared-governance structures and with more staff workers were more likely to conduct the four programs (all ps<0.05). Conclusion: About one third of LHDs were not conducting the four programs to improve access to health care in their jurisdictions in 2010. More resources are needed in order to strengthen LHDs' role of assurance of necessary health care, especially smaller LHDs.