Recorded presentation

Glen P. Mays, PhD, MPH, University of Arkansas, Mathematica Policy Research, 4301 West Markham, #820, Little Rock, AR 72205, 501-526-6633, GPMays@uams.edu and Paul K. Halverson, DrPh, Public Health Practice Program Office/Division of Public Health Systems Development and Research, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K39, Atlanta, GA 30341.

OBJECTIVE: The performance of public health services varies widely across communities, but little is known about how performance in one community may affect that of its neighboring communities. Positive “spill over” effects are possible if neighboring systems collaborate, share resources or learn from each other. Negative effects are also possible if systems compete unevenly for the same resources. This study examines these possibilities and explores the implications for inter-jurisdictional cooperation in the performance of essential services. METHODS: We use data from 315 local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001. We link performance measures from this program with secondary data on local public health department characteristics and on area health resources and community characteristics. Multivariate spatial dependence models are used to estimate how performance in one system affects that of its neighboring systems, while controlling for important differences in institutional and community characteristics across communities. RESULTS: We find significant patterns of spatial correlation in the performance measures, suggesting positive spill-over effects for some essential services and negative spill-over effects for other services. Moreover, we find evidence that positive spill-over effects result in higher average performance levels across all jurisdictions. CONCLUSIONS: Where positive spill-over effects exist, our findings suggest that performance improvement can be achieved through collaboration between neighboring public health systems. Where negative spill-over effects exist, neighboring systems should consider resource-sharing agreements and opportunities for consolidated service delivery in order to address these inefficiencies.

Learning Objectives:

Session participants will be able to (
• identify the institutional and community conditions that give rise to spill-over effects in public health service delivery; (
• determine the types of services most likely to exhibit positive and negative spill-over effects and why; (
• identify strategies for cooperating across public health jurisdictions to deliver services effectively and efficiently

Keywords: Performance Measurement, Service Delivery

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation