Should Health Departments Still Provide Clinical Services Post-ACA?
The decision whether or not to provide clinical services is treated as a supply and demand problem using a two by two matrix. A health department is positioned in one of four quadrants based on whether or not the state in which it is located is expanding Medicaid (demand) and whether or not the county in which it is located is a designated primary care health professional shortage area (supply). Combinations of the two variables were combined and plotted on a county-level map in four categories: 1) No Medicaid Expansion/No HPSA (Medium safety net role/Low opportunity to pursue reimbursement), 2) No Medicaid Expansion/ HPSA, (High safety net role/Low opportunity to pursue reimbursement), 3) Medicaid Expansion/No HPSA (Low safety net role/Low opportunity to pursue reimbursement), and 4) Medicaid Expansion/HPSA (Medium safety net role/High opportunity to pursue reimbursement).
There were 3,115 valid listed counties. 249 (8%) were in category 1, 1,609 (52%) were in category 2,184 (6%) were in category 3, and 1,073 (34%) were in category 4.
According to this simple analysis, health departments in only 6% of counties might be in a position to consider discontinuing clinical services; and, health departments in only 34% of counties may have a high opportunity to seek reimbursement for those services. Because there may be at least a medium safety net role for health departments in 94% of U.S. counties, the question of whether or not to continue to provide clinical services should be considered carefully.
Learning Areas:Administration, management, leadership
Public health administration or related administration
Identify two factors that health departments can use to evaluate their need to provide clinical services. Differentiate the four dimensions of the service supply/demand matrix. Describe the proportions of counties allocated to each supply/demand matrix cell and the implications of each.
Keyword(s): Health Care Delivery, Affordable Care Act
Qualified on the content I am responsible for because: I have been a health policy researcher for 16 years. I currently have a joint appointment as a Senior Adviser with CDC's Office of the Associate Director for Policy.
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.