Consolidation in Ohio local public health: Differences in expenditures, staffing & service

The objective of this study is to develop evidence regarding the potential effect of the consolidation of Ohio local health departments (LHD), from independent city run public health agencies into county wide organizational forms, on expenditures, staffing levels and service offerings of LHDs. Longitudinal data drawn from the Ohio Department of Health's Annual Financial Reports for the period between 2000 and 2011 are utilized for the analyses. Additional covariates such as community demographics and organizational characteristics are obtained from the PHAST Data Repository which is an ongoing collaborative data integration project drawing together multiple sources of data such as US Census data, the Area Resource Files and the NACCHO Profiles. In order to address the potential for both selection bias in which LHDs chose to consolidate and endogenous determination of spending decisions, the extended two part model for longitudinal data suggested by Deb, Munkin and Trivedi (2006) will be used to determine differences between consolidated and non-consolidated LHDs. Preliminary findings from a partial sample analysis indicate that cost savings, particularly in relation to administrative functions may be realized through consolidation. The gradient of savings appears in early analyses to reflect greater savings in consolidations of smaller city health departments as compared to consolidations involving larger LHDs.