Online Program

Recessions, risks, and reforms: Changes in interorganizational efforts to improve public health

Tuesday, November 5, 2013 : 5:30 p.m. - 5:45 p.m.

Glen Mays, PhD, MPH, College of Public Health, University of Kentucky, Lexington, KY
Objectives: The Affordable Care Act created new incentives for hospitals, insurers, employers, public health agencies, and others to contribute to activities designed to promote health and prevent disease an injury. At the same time, the economic recession has constrained government and private sector spending on health and health care, necessitating changes in the scope and scale of public health delivery. This study uses data from the 1998-2012 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, with a focus on hospitals, insurers, employers, and primary care providers; and (2) the degree to which selected organizations attenuate or accentuate changes made by peer organizations in public health contributions.

Methods: Our retrospective cohort design follows 350 U.S. communities over time using survey data collected initially in 1998 and again in 2006 and 2012. The surveys ask local public health officials to report on the availability of 20 recommended public health activities in the community, and which organizations contribute to each activity. We construct measures of the scope of public health activities contributed by each type of organization in each community and year, along with network analytic measures of organizational influence (density and centrality) within the local public health delivery network. Dynamic structural equation models are used to estimate complementarities, substitution effects, and network effects for each type of organization.

Results: The proportion of recommended public health activities delivered in the average community increased from 64% in 1998 to 70% in 2006, but fell back to 67% in 2012. More than three-quarters of communities experienced reductions in the scope of public health activities delivered between 2006 and 2012. Public health contributions by state and local government agencies and employers decreased steeply during this period (41%, 21%, and 21% reductions), while hospital and health insurer contributions declined by much smaller margins of 4.5% and 2.5%, respectively. Multivariate estimates show that hospital and health insurer contributions helped to attenuate the impact of government agency reductions in public health delivery through substitution effects, while physician practices and employers accentuated government reductions due to complementarities. The magnitude of these effects varied with organizational centrality within the local network.

Conclusions: Health system stakeholders respond differently to policy incentives and economic constraints that shape public health delivery. Private-sector contributions to public health appear to offset governmental reductions under certain organizational and community conditions. .

Learning Areas:

Administration, management, leadership
Biostatistics, economics
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Explain the roles played by health system organizations in delivering public health services. Identify policy and economic factors that lead health system organizations to change their contributions to public health activities

Keyword(s): Health Care Delivery, Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI on multiple research grants focusing on the organization, financing, and delivery of public health services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.