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Atwal S, Schmider J, Buchberger B, Boshnakova A, Cook R, White A, El Bcheraoui C. Prioritisation processes for programme implementation and evaluation in public health: A scoping review. Front Public Health 2023; 11:1106163. [PMID: 37050947 PMCID: PMC10083497 DOI: 10.3389/fpubh.2023.1106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundProgramme evaluation is an essential and systematic activity for improving public health programmes through useful, feasible, ethical, and accurate methods. Finite budgets require prioritisation of which programmes can be funded, first, for implementation, and second, evaluation. While criteria for programme funding have been discussed in the literature, a similar discussion around criteria for which programmes are to be evaluated is limited. We reviewed the criteria and frameworks used for prioritisation in public health more broadly, and those used in the prioritisation of programmes for evaluation. We also report on stakeholder involvement in prioritisation processes, and evidence on the use and utility of the frameworks or sets of criteria identified. Our review aims to inform discussion around which criteria and domains are best suited for the prioritisation of public health programmes for evaluation.MethodsWe reviewed the peer-reviewed literature through OVID MEDLINE (PubMed) on 11 March 2022. We also searched the grey literature through Google and across key websites including World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the International Association of National Public Health Institutes (IANPHI) (14 March 2022). Articles were limited to those published between 2002 and March 2022, in English, French or German.ResultsWe extracted over 300 unique criteria from 40 studies included in the analysis. These criteria were categorised into 16 high-level conceptual domains to allow synthesis of the findings. The domains most frequently considered in the studies were “burden of disease” (33 studies), “social considerations” (30 studies) and “health impacts of the intervention” (28 studies). We only identified one paper which proposed criteria for use in the prioritisation of public health programmes for evaluation. Few prioritisation frameworks had evidence of use outside of the setting in which they were developed, and there was limited assessment of their utility. The existing evidence suggested that prioritisation frameworks can be used successfully in budget allocation, and have been reported to make prioritisation more robust, systematic, transparent, and collaborative.ConclusionOur findings reflect the complexity of prioritisation in public health. Development of a framework for the prioritisation of programmes to be evaluated would fill an evidence gap, as would formal assessment of its utility. The process itself should be formal and transparent, with the aim of engaging a diverse group of stakeholders including patient/public representatives.
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Affiliation(s)
- Shaileen Atwal
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Jessica Schmider
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Barbara Buchberger
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Anelia Boshnakova
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Rob Cook
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Alicia White
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- *Correspondence: Charbel El Bcheraoui,
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Distributing Local Resources for Public Health Preparedness Grants: A Data-Driven Approach. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 26:349-356. [PMID: 30789592 DOI: 10.1097/phh.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To simulate allocations of Public Health Emergency Preparedness funds to counties using alternative metrics of need, minimum allocation amounts, and the proportion earmarked for discretionary considerations. DESIGN We developed a county-level community resilience index of 57 New York State counties using publicly available indicators, which we incorporated into an interactive spreadsheet of 8 hypothetical allocation formulas with different combinations of population size, the index and its 5 domains, and population density. Simulations were compared with the 2013-2014 fiscal year grant allocation. RESULTS New York allocated $6.27 million to counties outside New York City, with a median allocation of $78 038, ranging from $50 825 to $556 789. These allocations would vary under different strategies, with the largest changes among sparsely populated counties that currently receive a minimum allocation of $50 825. Allocations were sensitive to changes in minimum allocation, amount earmarked for discretionary allocation, and need indicator. CONCLUSIONS Population-based approaches are commonly used but ignore important dimensions of need. It is feasible to include robust local community resilience measures in formulas, and interactive spreadsheet models can help stakeholders evaluate the consequences of alternative funding strategies.
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Park S, Bekemeier B, Flaxman AD. Understanding data use and preference of data visualization for public health professionals: A qualitative study. Public Health Nurs 2021; 38:531-541. [PMID: 33569821 DOI: 10.1111/phn.12863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to assess public health professionals' use of data, information, and evidence and to understand perceptions and preferences regarding data visualization to inform future design of data visualization tools. DESIGN We conducted qualitative interviews with public health professionals who use data for decision making as part of community health assessment and program planning from state and local health departments across six states. RESULTS We identified four themes: 1) collection of data, information, and evidence; 2) management and analysis of data and information to inform decisions; 3) use of data to support public health practice; and 4) preferences for data visualization and how visualization is being used. Public health professionals use data, information, and evidence from various resources for communicating with co-workers, stakeholders, and the public, and decision making regarding their programs and services. CONCLUSION Data visualization tools can help public health professionals improve their understanding and communication, their education of stakeholders, and their decision making using data, information, and evidence. Public health professionals believe in the value of using data, information, and evidence. Opportunities exist in ways to support public health professionals' data use by adopting data visualization tools and by mitigating systematic challenges in public health information systems.
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Affiliation(s)
- Seungeun Park
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon, Korea
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Abraham D Flaxman
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington School of Medicine, Seattle, WA, USA
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MacKinnon KR, Gómez-Ramírez O, Worthington C, Gilbert M, Grace D. An institutional ethnography of political and legislative factors shaping online sexual health service implementation in Ontario, Canada. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1854182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Kinnon Ross MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Social Work, York University, Toronto, Ontario, Canada
| | - Oralia Gómez-Ramírez
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Succession Planning in State Health Agencies in the United States: A Brief Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:473-478. [PMID: 29112036 DOI: 10.1097/phh.0000000000000700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Approximately 25% of the public health workforce plans to retire by 2020. Succession planning is a core capability of the governmental public health enterprise; however, limited data are available regarding these efforts in state health agencies (SHAs). METHODS We analyzed 2016 Workforce Gaps Survey data regarding succession planning in SHAs using the US Office of Personnel Management's (OPM's) succession planning model, including 6 domains and 27 activities. Descriptive statistics were calculated for all 41 responding SHAs. RESULTS On average, SHAs self-reported adequately addressing 11 of 27 succession planning activities, with 93% of SHAs adequately addressing 1 or more activities and 61% adequately addressing 1 or more activities in each domain. CONCLUSIONS The majority of OPM-recommended succession planning activities are not being addressed, and limited succession planning occurs across SHAs. Greater activity in the OPM-identified succession planning domains may help SHAs contend with significant turnover and better preserve institutional knowledge.
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The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research. J Nurs Adm 2019; 49:496-502. [PMID: 31517757 DOI: 10.1097/nna.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.
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Leider JP, Alfonso N, Resnick B, Brady E, McCullough JM, Bishai D. Assessing The Value Of 40 Years Of Local Public Expenditures On Health. Health Aff (Millwood) 2019; 37:560-569. [PMID: 29608371 DOI: 10.1377/hlthaff.2017.1171] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The US public and private sectors now spend more than $3 trillion on health each year. While critical studies have examined the relationship between public spending on health and health outcomes, relatively little is known about the impact of broader public-sector spending on health. Using county-level public finance data for the period 1972-2012, we estimated the impact of local public hospital spending and nonhospital health spending on all-cause mortality in the county. Overall, a 10 percent increase in nonhospital health spending was associated with a 0.006 percent decrease in all-cause mortality one year after the initial spending. This effect was larger and significant in counties with greater proportions of racial/ethnic minorities. Our results indicate that county nonhospital health spending has health benefits that can help reduce costs and improve health outcomes in localities across the nation, though greater focus on population-oriented services may be warranted.
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Affiliation(s)
- Jonathon P Leider
- Jonathon P. Leider ( ) is associate faculty in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Natalia Alfonso
- Natalia Alfonso is a research associate in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Beth Resnick
- Beth Resnick is a senior scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Eoghan Brady
- Eoghan Brady is a senior technical advisor in Global Health Financing at the Clinton Health Access Initiative, Inc., in Boston, Massachusetts. At the time this research was conducted, he was a doctoral candidate in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - J Mac McCullough
- J. Mac McCullough is an assistant professor in the School for the Science of Health Care Delivery, Arizona State University, in Phoenix
| | - David Bishai
- David Bishai is a professor in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Leider JP, Resnick B, Bishai D, Scutchfield FD. How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels. Annu Rev Public Health 2018; 39:471-487. [PMID: 29346058 DOI: 10.1146/annurev-publhealth-040617-013455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.
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Affiliation(s)
- Jonathon P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205, USA; ,
| | - Beth Resnick
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205, USA; ,
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland 21205, USA;
| | - F Douglas Scutchfield
- Department of Health Services Management, University of Kentucky, Lexington, Kentucky 40536-0003, USA;
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Iskrov G, Miteva-Katrandzhieva T, Stefanov R. Health Technology Assessment and Appraisal of Therapies for Rare Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:221-231. [PMID: 29214575 DOI: 10.1007/978-3-319-67144-4_13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Innovative rare disease therapies and health technology assessment (HTA) share a lot of similarities. Both represent cases of interaction of epidemiology and health economics. Both are relatively new topics in public health practice. And both pose a lot of challenges to rare disease stakeholders who are currently looking for tools to support the timely access to innovative treatments while putting budget spending in order. This is why optimisation of assessment and appraisal of new rare disease therapies is a fundamental issue in rare disease health policy. Rare disease patients and caregivers expect prolonged life expectancy and improved quality of life and they perceive innovative health technologies as a rightful way to achieve these objectives.Multi-criteria decision analysis (MCDA) provides a structured, transparent approach to identify preferred alternatives by means of combined calculation of relative importance of different criteria and performance of the alternatives on these criteria. The labyrinth of competing interests and numerous stakeholders involved is why innovative rare disease health technologies make an excellent case study of the integration between HTA and MCDA. This kind of formalisation of decision-making is perceived as fair and legitimate, leading to a balance and agreement. MCDA provides a stage for a debate of policy priorities, health system specifics and societal attitudes, while also addressing the impact of rarity on all criteria and considerations.
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Affiliation(s)
- Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria. .,Institute for Rare Diseases, Plovdiv, Bulgaria.
| | - Tsonka Miteva-Katrandzhieva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.,Institute for Rare Diseases, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.,Institute for Rare Diseases, Plovdiv, Bulgaria
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The health systems' priority setting criteria for selecting health technologies: A systematic review of the current evidence. Med J Islam Repub Iran 2016; 30:329. [PMID: 27390699 PMCID: PMC4898853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/12/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the recent years, using health technologies to diagnose and treat diseases has had a considerable and accelerated growth. The proper use of these technologies may considerably help in the diagnosis and treatment of different diseases. On the other hand, unlimited and unrestricted entry of these technologies may result in induced demand by service providers. The aim of this study was to determine the appropriate criteria used in health technologies priority-setting models in the world. METHODS Using MESH and free text, we sought and retrieved the relevant articles from the most appropriate medical databases (the Cochrane Library, PubMed and Scopus) through three separate search strategies up to March 2015. The inclusion criteria were as follows: 1) Studies with specific criteria; 2) Articles written in English; 3) Those articles conducted in compliance with priority setting of health technologies. Data were analyzed qualitatively using a thematic synthesis technique. RESULTS After screening the retrieved papers via PRISMA framework, from the 7,012 papers, 40 studies were included in the final phase. Criteria for selecting health technologies (in pre assessment and in the assessment phase) were categorized into six main themes: 1) Health outcomes; 2) Disease and target population; 3) Technology alternatives; 4) Economic aspects; 5) Evidence; 6) and other factors. "Health effects/benefits" had the maximum frequency in health outcomes (8 studies); "disease severity" had the maximum frequency in disease and target population (12 studies); "the number of alternatives" had the maximum frequency in alternatives (2 studies); "cost-effectiveness" had the maximum frequency in economic aspects (15 studies); "quality of evidence" had the maximum frequency in evidence (4 studies); and "issues concerning the health system" had the maximum frequency in other factors (10 studies). CONCLUSION The results revealed an increase in the number of studies on health technologies priority setting around the world, and emphasized the necessity of application of a multi- criteria approach for appropriate decision making about healthcare technologies in the health systems.
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Iskrov G, Stefanov R. Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria. Balkan Med J 2016; 33:27-35. [PMID: 26966615 DOI: 10.5152/balkanmedj.2015.15185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. AIMS The study's aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process - the criteria used - because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. STUDY DESIGN Cross-sectional study. METHODS The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders - medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. RESULTS Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. CONCLUSION Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen involvement in public health decision-making. Drug reimbursement criteria have to be integrated into legitimate public health decision support tools that ensure the achievement of national public health objectives. These recommendations could be expanded to all Eastern European countries who share common public health problems.
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Affiliation(s)
- Georgi Iskrov
- Department of Social Medicine and Public Health, Medical University of Plovdiv Faculty of Public Health, Plovdiv, Bulgaria
| | - Rumen Stefanov
- Department of Social Medicine and Public Health, Medical University of Plovdiv Faculty of Public Health, Plovdiv, Bulgaria
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Bernet PM, Singh S. Economies of scale in the production of public health services: an analysis of local health districts in Florida. Am J Public Health 2015; 105 Suppl 2:S260-7. [PMID: 25689207 DOI: 10.2105/ajph.2014.302350] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the existence and the extent of scale and scope economies in the delivery of public health services. We also tested the strength of agency, population, and community characteristics that moderate scale and scope economies. METHODS We collected service count and cost data for all Florida local health districts for 2008 and 2010, complemented with data on agency, population, and community characteristics. Using translog cost functions, we built models of operating efficiencies for 5 core public health activities: communicable disease surveillance, chronic disease prevention, food hygiene, on-site sewage treatment, and vital records. RESULTS Economies of scale were found in most activities, with cost per unit decreasing as volume increased. The models did not, however, identify meaningful economies of scope. CONCLUSIONS Consolidation or regionalization might lower cost per unit for select public health activities. This could free up resources for use in other areas, further improving the public's health.
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Affiliation(s)
- Patrick M Bernet
- Patrick M. Bernet is with the College of Business, Florida Atlantic University, Boca Raton. Simone Singh is with the School of Public Health, University of Michigan, Ann Arbor
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