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Impact of Economic Constraints on Public Health Delivery Systems Structures
Sharla A Smith1, Glen P Mays1, Holly C Felix1
1Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock.
Objectives:
We estimated the effect of economic constraints on public health delivery systems (PHDS) density and centrality during 3 time periods, 1998, 2006, and 2012.
Methods:
We obtained data from the 1998, 2006, and 2012 National Longitudinal Study of Public Health Agencies; the 1993, 1997, 2005, and 2010 National Association for County and City Health Officials Profile Study; and the 1997, 2008, and 2011 Area Resource Files. We used multivariate regression models for panel data to estimate the impact of economic constraints on PHDS density and centrality.
Results:
Findings indicate that economic constraints did not have a significant impact on PHDS density and centrality over time but population is a significant predictor of PHDS density, and the presence of a board of health (BOH) is a significant predictor of PHDS density and centrality. Specifically, a 1% increase in population results in a significant 1.71% increase in PHDS density. The presence of a BOH is associated with a 10.2% increase in PHDS centrality, after controlling for other factors.
Conclusions:
These findings suggest that other noneconomic factors influence PHDS density centrality.
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