Performance Improvement 2001. Where are we with Health Reform and the Health of the Public: Observations from the Field


In 1994, Baker and colleagues presented a framework for examining how the health of the public can be improved during a period of substantial change in the health system. This article reviews Baker's framework for refocusing and reinvigorating public health in an era of change and provides observations of the local changes. The observations are based on 12 site visits to health departments in randomly selected communities that are representative of the U.S. population. Data for this study were collected as part of the Public Health Tracking Study, a collateral study to the Community Tracking Study that is funded by the Robert Wood Johnson Foundation. It was found that many of Baker and colleague's predictions were on target, but others fall short. Most health departments have divested direct service delivery and instead are focusing on population-based activities. The local health department, however, is a leader in providing health information and planning and mobilizing the community around health issues. It was also found that health departments are having difficulty assuring the quality and availability of services for those in need. Lack of enforcement abilities, especially with regard to managed care organizations, limits health departments' ability to influence the quality of care. Assuring services to low-income residents may become even more difficult as questions remain over the stability and commitment of managed care organizations to provide services to the Medicaid population.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Matthew Guidry, 202-401-7780

PIC ID: 6325

PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ