Trends in revenue streams and service delivery among Connecticut local health jurisdictions (2001-2010): The impact of economic conditions and other factors

Background: Motivated by concerns that the 2007-2009 recession had reduced Connecticut Local Health Jurisdictions' (LHJs) revenue and that LHJs might adjust their service mix in response, this study investigated: (i) whether changes in economic conditions were associated with changes in LHJ fee revenue or service provision, and (ii) what other factors explained variation in fee revenue and service provision over time. Methods: Connecticut Department of Public Health (DPH) annual report data (2001-2010) and publicly available data on economic conditions were used to develop longitudinal mixed effect models for 3 types of fee revenue and 17 service indicators. Trends in revenue streams and services were characterized; hypotheses were tested using t-tests of the estimated coefficients. Results: Changes in unemployment rate and number of housing permits did not explain variation in LHJ revenue. Changes in municipal funding explained variation in license fees. Part time and district LHJs received lower program and immunization clinic fees than full time LHJs, and rural LHJs received lower license fees than urban LHJs. Higher unemployment was associated with decreases in the number of environmental health personnel and a lower likelihood of having a health educator on staff. Rural LHJs had higher levels of environmental health personnel, sewage lots tested, and septic and well permits issued. Percent of required food service establishment inspections completed were consistent over time across all types of LHJs.

Conclusions: There is limited evidence in the annual report data that economic downturns affected LHJs' fee revenue or service provision during the 2001-2010 period.