The transformation of a local health department

In 1993, the health department serving the city of Amarillo, Texas, and surrounding communities was merged with the city's tax-supported Hospital District, which operated a public hospital and clinics providing medical care to poor people. Three years later, the public hospital and clinics were sold to a for-profit corporation, privatizing most medical services for the poor. The proceeds from this sale created a community trust fund for the provision of indigent care and eliminated Hospital District taxes. The city government reassumed operation of the Health Department, which redefined itself primarily in terms of public health functions not involving the provision of personal health services. These functions included communicable disease control, monitoring the health status of the community, identification of public health problems, and health promotion. The new Health Department, with a smaller budget and fewer staff members, is now funded by the for-profit corporation that purchased the public hospital, the community trust fund, and grants from the state health department.