Jurisdiction Size and Local Public Health Spending

I thank Carolyn Leep of the National Association of County and City Health Officers for helping me secure the necessary data. Data for this study were obtained from the 2005 National Profile of Local Public Health Agencies, a project supported through a cooperative agreement between the National Association of County and City Health Officials and the Centers for Disease Control and Prevention. I also thank the two anonymous referees of this journal for their many helpful suggestions for improving the paper

Geographic Variation in Public Health Spending: Correlates and Consequences

OBJECTIVES: To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. DATA SOURCES AND SETTING: Three cross-sectional surveys of the nation\u27s 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. STUDY DESIGN: A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. PRINCIPAL FINDINGS: The top 20 percent of communities had public health agency spending levels \u3e13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. CONCLUSIONS: The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activitie

Explaining the efficiency of local health departments in the U.S.: an exploratory analysis

Public health, Efficiency, Data envelopment analysis,