Understanding the organization of public health delivery systems: an empirical typology.
BACKGROUND
Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure.


METHODS
This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system.


RESULTS
Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations.


CONCLUSIONS
Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.
Mays
Glen P
GP
Fay W. Boozman College of Public Health, University of Arkansas, Little Rock, AR 72205, USA. gpmays@uams.edu
Scutchfield
F Douglas
FD
Bhandari
Michelyn W
MW
Smith
Sharla A
SA
D015331:Cohort Studies; D019058:Community Networks / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration*; D011634:Public Health; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012041:Regional Medical Programs / Q000458:organization & administration; D014481:United States