Cross-Jurisdictional Resource Sharing in Local Health Departments: Implications for Services, Quality, and Cost

Abstract

BackgroundForty one percent of local health departments in the U.S. serve jurisdictions with populations of 25,000 or less. Researchers, policymakers, and advocates have long questioned how to strengthen public health systems in smaller municipalities. Cross-jurisdictional sharing may increase quality of service, access to resources, and efficiency of resource use.ObjectiveTo characterize perceived strengths and challenges of independent and comprehensive sharing approaches, and to assess cost, quality, and breadth of services provided by independent and sharing health departments in Connecticut (CT) and Massachusetts (MA).MethodsWe interviewed local health directors or their designees from 15 comprehensive resource-sharing jurisdictions and 54 single-municipality jurisdictions in CT and MA using a semi-structured interview. Quantitative data were drawn from closed-ended questions in the semi-structured interviews; municipal demographic data were drawn from the American Community Survey and other public sources. Qualitative data were drawn from open-ended questions in the semi-structured interviews.ResultsThe findings from this multistate study highlight advantages and disadvantages of two common public health service delivery models – independent and shared. Shared service jurisdictions provided more community health programs and services, and invested significantly more ($120 per thousand (1K) population vs. $69.5/1K population) on healthy food access activities. Sharing departments had more indicators of higher quality food safety inspections (FSIs), and there was a non-linear relationship between cost per FSI and number of FSI. Minimum cost per FSI was reached above the total number of FSI conducted by all but four of the jurisdictions sampled. Independent jurisdictions perceived their governing bodies to have greater understanding of the roles and responsibilities of local public health, while shared service jurisdictions had fewer staff per 1,000 population.ImplicationsThere are trade-offs with sharing and remaining independent. Independent health departments serving small jurisdictions have limited resources but strong local knowledge. Multi-municipality departments have more resources but require more time and investment in governance and decision-making. When making decisions about the right service delivery model for a given municipality, careful consideration should be given to local culture and values. Some economies of scale may be achieved through resource sharing for municipalities <25,000 population.

Involvement of Local Health Departments in Obesity Prevention: A Scoping Review

“…The apparent use of data in relation to OP specifically among rural LHDs was particularly lacking, with only one of the 6 rural-focused studies describing data utilization. 72 Often, rural LHDs develop community interventions or policies, using the evidence generated from urban populations, as urban data are often more accessible or where resources support strong evaluations and research. 17 These urban data and the evidence generated, however, may not be relevant to application in rural communities.…”

“…One study cited cross-jurisdictional resource-sharing to increase LHD participation in OP activity. 72 Another report described a co-mentoring program between LHDs and local entities including government agencies, community organizations, and academic institutions to better combine expertise to implement built environment interventions. 37 Of the 52 publications, approximately 52% (27/52) described efforts in policy development and implementation for OP.…”

“…55,64,67 LHD involvement was unknown (U) in approximately 17% (9/52) of publications due to lack of description in their methods. 14,15,[72][73][74][75][76][77][78] These unknown studies typically used large data sets, such as the NACCHO Profile of Local Health Departments Survey 29 that broadly asks LHD leaders about nutrition, PA, and policy interventions (among other topics) in their jurisdictions. Although the NACCHO Profile Survey asks whether OP activities are "LHD led," 29 the survey does not state how extensively LHDs engage in the particular OP activity or whether the LHD monitors or evaluates the intervention.…”

“…These included policies for food store produce availability, 54 school-based nutrition, 32,39,40,44,[52][53][54][55]69 vending machines, 41,58,69 menu labeling, 39,68,70,72 and limiting sugary beverages. 14,15,54,72 Some studies also cited PA policies. 51,68 Fifty percent of publications (26/52) included built environment interventions.…”

An empirical analysis of social public resources digital sharing system: Dissipative structure theory

“…It can promote the interaction between education and manufacturing R&D [ 9 ]. Similarly, in healthcare, a cross-jurisdictional resource-sharing service model in local health departments can provide at least as many mandated and more nonmandated services with greater quality [ 10 ]. However, public resource sharing is affected by the benefits, costs, and risks of sharing [ 11 ].…”