Context: 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. Findings: 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.

he study described in this article identifies local public health agency capacity characteristics that are related to their local public health systems' performance scores on the CDC's National Public Health Performance Standards Program assessment instrument. Public health system performance scores from a test version of the National Public Health Performance Standards instrument (5b) from county and city/county jurisdictions in three states were matched to organizational capacity data from the 1997 National Association of County and City Health Officials profile of health departments, resulting in a sample of 152 jurisdictions. Twenty-eight capacity variables from the profile and all 10 scores on the Essential Public Health Services plus the total performance score were analyzed in 11 separate multivariate regression models. Public health agency capacities in the areas of funding, organizational leadership, and certain nonprovider partnerships were found to be significantly related to public health system performance. Further study is needed to determine if these relationships between agency capacities and system performance are found, with data from other states now using the nationally released performance assessment instruments and with capacity measures that are more specific for evaluating public health system performance.

This study examined the relationship between community and system characteristics of 353 local public health agencies and local public health system performance by revisiting previous research by Mays et al and Scutchfield et al. More recent and coterminous data were used. Local public health agency characteristics were obtained from the National Association of City and County Health Officials' 2005 National Profile of Local Public Health Departments and performance data were obtained from version 1 of the National Public Health Performance Standards Program local performance assessment instrument. Descriptive analyses and multivariate analyses similar to the two previous studies were employed. Population size, presence of a local board of health and whether the board makes policy, educational background of the local public health agency's top executive, and jurisdiction type were found to be important predictors of local public health performance. These findings support some of the earlier findings but do not support all the findings of the earlier studies. Variances are discussed. This study provides researchers and practitioners with an evidence base from which to make suggestions regarding characteristics, many changeable, which may influence system performance.

This review examines past, current, and future issues in developing and using public health performance data for improving the public health system. Issues are explored relating to public health performance data collection and analysis, and inferences made from those data, largely by examining public health performance data collected since the Year 2000. More research is needed to improve understanding of the context in which public health systems operate and how that context affects performance and its relationship to health outcomes. There are major areas of concern that must be addressed by the public health practice organizations, governmental public health entities, and the public health systems research communities, such as ensuring that data are collected on public health infrastructure, practice, and performance and that data from various sources are collected in a harmonious fashion. At issue also is the examination of the impact of new arrivals to the public health system, such as accreditation and credentialing of the public health workforce, on public health system performance.

BackgroundHealth coverage in the United States will be increased to nearly universal levels under the Affordable Care Act (ACA). In order to better understand the impact of the type of health insurance and health outcomes, there is a need to examine health disparities and inequalities between the insured and the uninsured based on their eligibility for coverage.MethodsThe current study used the data from the Medical Expenditure Panel Survey 2012 (MEPS). Selected health characteristics and access to care items were compared in regard to the insurance status: private, public, the uninsured, but likely eligible for Medicaid expansion (EME), and the uninsured, but likely required to purchase health plans through the health insurance exchanges (RPIE).ResultsAnalyses showed that 17.2 % of US adults ages 27–64 were eligible as EME and 12.9 % as RPIE in 2012. Compared to the insured groups, the uninsured who were eligible for coverage reported fewer health problems than those insured privately and publicly. However, they also reported less use of health care, including preventive health service, screenings, and unmet health care needs.ConclusionsThe ACA aims to increase coverage options and access to treatment and preventive health care services for the majority of the uninsured US population. However, it may not play as significant of a role in improving health among the uninsured, in particular, those eligible for the Medicaid expansion.

This research provides information regarding the determinants of system change, and may help public health leaders to better prepare for the impacts of change in the areas discussed. It may also help those who are seeking to implement change to determine the contextual factors that need to be in place before change can happen, or how best to implement change in the face of contextual factors that are beyond their control.

SYNOPSISPublic health systems and services research (PHSSR) is defined as "a field of study that examines the organization, financing, and delivery of public health services within communities and the impact of those services." PHSSR is a relatively young field and suffers from a paucity of research resources. In this article, we describe the development and utility of a data resource, housed on the Health Services and Sciences Research Resources website maintained by the National Library of Medicine, which provides easy access to instruments, indices, and datasets that are relevant to PHSSR researchers. We also investigate efforts to promote the use and dissemination of these data resources, including the awarding of research grants and the organization of a PHSSR conference. While public health systems and services research (PHSSR) 1 is a relative newcomer to research synthesis and evidence-based practice, the field of health services research (HSR) has a history that extends several decades. Public Health Systems and Services Research2,3 Health services researchers have long recognized the need for databases that are suitable for secondary data analysis, as well as data collection instruments that have been refined through psychometric and common use procedures. These resources have enabled health services researchers to become productive quickly, and have helped HSR to become a well-defined area of inquiry.The National Library of Medicine's (NLM's) National Information Center on Health Services Research and Health Care Technology sponsors several research tools of use to HSR, including the Health Services and Sciences Research Resources (HSRR) database-an Internet database that contains approximately 800 records of various research resources (i.e., instruments/indices, datasets, and software) that have utility for HSR. NLM also sponsors the Health Services Research Projects in Progress (HSRProj) website, which gives researchers access to descriptions of current research projects in HSR. These NLM Web-based resources serve as a clearinghouse of information on HSR data and research.The efforts of researchers and the NLM to make relevant research readily available have contributed to the support, identity, and respect that HSR currently enjoys. Many of the NLM HSR resources can also be useful in PHSSR.3 However, a need exists for resources that serve the specific needs of those conducting research in the field of public health, particularly those involved in PHSSR.PHSSR is an area of inquiry that examines the organization, financing, delivery, and impact of public health services within communities, and has emerged as a vehicle for applying the concepts and methods of HSR to public health settings. However, PHSSR has been hindered by the lack of systematic resources that satisfy the information needs of researchers engaging in PHSSR. Anderson and colleagues describe the current state of PHSSR: "At a time when demand for evidencedbased practice (in public health) has reached its peak, a parallel understanding ...

No abstract