Economic coping mechanisms: Perspectives from Connecticut local health directors

Background: Motivated by concerns that the 2007-2009 recession had led to a reduction in Connecticut Local Health Jurisdictions' (LHJs) revenue and that LHJs might need to adjust their service provision in response, this study investigated: the perspectives of local health directors in Connecticut on (1) key factors influencing revenue levels and services provided, and (2) coping mechanisms available to respond to reductions in revenue. Methods: In-depth interviews were conducted with 17 directors of local health jurisdictions (LHJs) in order to examine expert opinions on how specific components of LHJ revenue streams affect service delivery. Interviews were recorded, transcribed, and coded for themes relating to LHJ coping mechanisms in response to reduced revenues. Coding was conducted independently by two researchers, and coded themes were then iteratively grouped into categories and sub-categories.

Results: LHJs use diverse strategies to respond to reduced revenues. These strategies include increasing revenue from alternative sources, services, and staffing, as well as the strategic use of politics and partnerships. Although the study identified a variety of coping mechanisms, the effects of different coping mechanisms on the quality and intensity of service provision is an area for further research.

Conclusions: LHJs are not passive in the face of budget cuts, but instead respond creatively to try to maintain important public health services. LHJs' adjustments, however, often come through internal management of staff time and administrative resources, which may tend to obscure the long-term costs of public health budget cuts in such areas as staff morale and turnover.