The adoption and discontinuation of clinical services by local health departments

Charleen Hsuan, Hector P. Rodriguez

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Objectives: We identified factors associated with local health department (LHD) adoption and discontinuation of clinical services. Methods: We used multivariate regression with 1997 and 2008 LHD survey and area resource data to examine factors associated with LHDs maintaining or offering more clinical services (adopter) versus offering fewer services (discontinuer) over time and with the number of clinical services discontinued among discontinuers. Results: Few LHDs (22.2%) were adopters. The LHDs were more likely to be adopters if operating in jurisdictions with local boards of health and not in health professional shortage areas, and if experiencing larger percentage increase in non-White population and Medicaid managed care penetration. Discontinuer LHDs eliminated more clinical services in jurisdictions that decreased core public health activities' scope over time, increased community partners' involvement in these activities, had larger increases in Medicaid managed care penetration, and had lower LHD expenditures per capita over time. Conclusions: Most LHDs are discontinuing clinical services over time. Those that cover awide range ofcore public health functions are less likelytodiscontinue services when residents lack care access. Thus, the impact of discontinuation on population health may be mitigated.

Original languageEnglish (US)
Pages (from-to)124-133
Number of pages10
JournalAmerican journal of public health
Volume104
Issue number1
DOIs
StatePublished - Jan 2014

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

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