Understanding the Organization of Public Health Delivery Systems: An Empirical Typology

Abstract

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.

Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security

“…Engagement and self-sufficiency also require the capacity to mobilize partnerships. Models such as the Mobilizing for Action through Planning and Partnership (MAPP) have been developed to support community mobilization efforts (Mays, 2010). Finally, state and local health agencies are increasingly utilizing performance standards, measures, monitoring, and quality improvement processes.…”

“…Models such as Mobilizing for Action through Planning and Partnership (MAPP), 1 a community-wide assessment and strategic planning tool for improving health, have been developed to support community mobilization efforts (Mays, 2010). However, engagement and self-sufficiency require dedicated and sustainable resources, committed leadership, and sophisticated communication skills (Salinsky, 2010).…”

Small-Firm Networks and strategies for consolidation: evidence from the Brazilian context

“…The third factor for the analysis of the organization and management of SFNs relies on the services portfolio offered by the SFN to participating firms. Several studies investigated the role of SFNs in the implementation of services put together by participating firms (Graddy & Chen, 2006;Isett, Mergel, Leroux, Mischen & Rethemeyer, 2011;Mays & Scutchfield, 2010;McGuire, 2006;Milward & Provan, 2006). Furthermore, the NAO can offer services Small-Firm Networks and strategies for consolidation: evidence from the Brazilian context focused on improving members' competitiveness by providing solutions that individual firms would not be able to develop themselves (Best, 1990, Bazzoli et al, 2003Shortell, Zukoski & Alexander, 2002).…”

An Infrastructure to Support the Visual Analysis of Data from the Brazilian Public Health System

“…Concerns about gaps in both the availability and quality of public health services have hit the headlines in response to both new and persistent health risks [1]. For this reason, decision makers and practitioners must be careful about the allocation, management, and administration of public health resources [2].…”

“…The Decentralized Hospital Information System (SIHD) registers health unit admissions. Data related to these admissions are provided monthly by the health units that provide services to citizens on behalf of SUS 1 . The SUS health unit Information System (SIHSUS) supports the management of the medical billing invoices sent by health units from all parts of the country that provide services on behalf of SUS 2 .…”