Institutional and economic determinants of public health system performance.
OBJECTIVE
Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services.


METHODS
Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services.


RESULTS
Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services.


CONCLUSIONS
Reconfiguring the organization and financing of public health systems in some communities-such as through consolidation and enhanced intergovernmental coordination-may hold promise for improving the performance of essential services.
Mays
Glen P
GP
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA. gpmays@uams.edu
McHugh
Megan C
MC
Shim
Kyumin
K
Perry
Natalie
N
Lenaway
Dennis
D
Halverson
Paul K
PK
Moonesinghe
Ramal
R
D003153:Community Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D015980:Public Health Practice / Q000191:economics* / Q000331:legislation & jurisprudence; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*