Understanding the Organization of Public Health Delivery Systems: An Empirical Typology
Article first published online: 24 MAR 2010
© 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
Volume 88, Issue 1, pages 81–111, March 2010
How to Cite
MAYS, G. P., SCUTCHFIELD, F. D., BHANDARI, M. W. and SMITH, S. A. (2010), Understanding the Organization of Public Health Delivery Systems: An Empirical Typology. Milbank Quarterly, 88: 81–111. doi: 10.1111/j.1468-0009.2010.00590.x
- Issue published online: 24 MAR 2010
- Article first published online: 24 MAR 2010
- Public health administration;
- multi-institutional systems;
- community health networks
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.