title: Provision of Personal Healthcare Services by Local Health Departments: 2008-2013.
abstract: BACKGROUND
  The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008-2013 and examine the association between provision of personal healthcare services and per capita public health expenditures.
  
  
  METHODS
  Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014.
  
  
  RESULTS
  The mean number of personal healthcare services provided by LHDs did not change significantly in 2008-2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services' share of revenue and per capita expenditures (b=0.57, p<0.001).
  
  
  CONCLUSIONS
  A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services.
authors.affiliation: Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina. Electronic address: luoh@ecu.edu.
authors.forename: Huabin
authors.initials: H
authors.lastname: Luo
authors.affiliation: Office for State, Tribal, Local and Territorial Support, CDC, Atlanta, Georgia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Sotnikov
authors.affiliation: Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Nancy
authors.initials: N
authors.lastname: Winterbauer
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005102:Health Expenditures; D006801:Humans; D009111:Local Government; D015233:Models, Statistical; D011634:Public Health / Q000191:economics*; D011795:Surveys and Questionnaires