Public health delivery systems: evidence, uncertainty, and emerging research needs

The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and ou...

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Bibliographic Details
Published in:American journal of preventive medicine 2009-03, Vol.36 (3), p.256-265
Main Authors: Mays, Glen P, Smith, Sharla A, Ingram, Richard C, Racster, Laura J, Lamberth, Cynthia D, Lovely, Emma S
Format: Article
Language:English
Subjects:
Delivery of Health Care - economics
Delivery of Health Care - manpower
Delivery of Health Care - organization & administration
Efficiency, Organizational
Financing
Financing, Government
Governance
Humans
Outcome and Process Assessment (Health Care)
Public health
Public Health - economics
Public Health - manpower
Public Health - methods
Public Health Administration - economics
Public Health Administration - manpower
Research - organization & administration
Service delivery
Staffing
United States
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Description
Summary:The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing.
ISSN:0749-3797
1873-2607
DOI:10.1016/j.amepre.2008.11.008