A preliminary comparison between local public health units in the Canadian Province of Ontario and in the United States.
This comparison between public health departments in the United States and in the Canadian Province of Ontario addresses the funding and staffing and the size and program content of local health departments after Canada's national health reform provided universal access to personal health services. Ontario's local health departments are required to provide a uniform set of public health services. In the United States, there is substantial variation among jurisdictions in kinds and amounts of services delivered. Ontario health units have staff sizes and budget levels that increase in proportion to population served, like those in the United States. But in Ontario, per capita expenditures increase with decreasing population, while the reverse is true in the United States. This anomaly may be attributed to lack of critical staff or elimination of key programs in small U.S. departments. Medical care of indigents probably accounts for the increased per capita costs seen in very large U.S. health departments. An estimated price for uniform public health services meeting the Ontario requirements in all U.S. jurisdictions as they were organized in 1989 is $5.8 billion per annum (not adjusted for inflation). If smaller health departments were consolidated, a savings of more than $1 billion could be realized. Even with this reorganization, average expenditures in smaller U.S. health departments would need to be doubled, and staff sizes increased by about 50 percent to meet Ontario's uniform public health program standards.
Schade
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District Health Department No. 2, West Branch, MI 48661.
D003625:Data Collection; D006077:Government Agencies / Q000191:economics / Q000592:standards; D006801:Humans; D009864:Ontario; D011634:Public Health / Q000191:economics / Q000592:standards; D011635:Public Health Administration / Q000191:economics / Q000706:statistics & numerical data*; D013219:State Government; D014481:United States; D000078329:Workforce