State and health services
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State and Health Services: An Overview
Organizational Structure of State and Local Public Health Agencies
The structure and organization of state and local public health agencies in the U.S. are diverse and complex. Public health services are delivered through a mix of local, state, and tribal governmental and nongovernmental agencies, with authority structures categorized as centralized (28%), decentralized (37%), or combined (35%)1. Organizational characteristics such as population size, per capita spending, and leadership have been found to influence public health performance1. However, there is limited evidence on how these characteristics directly impact health outcomes, highlighting a need for more comprehensive studies1.
Changes in State Health Department Structures
Between 1990 and 2009, there were significant changes in the organizational structures of state health-related departments. Many states combined multiple health functions, such as public health and Medicaid, within the same agency2. This consolidation often led to a decrease in the share of the state budget allocated to Medicaid, while public health allocations remained unchanged2. The dynamic nature of these organizational structures underscores the importance of understanding how such changes impact resource allocation and health policy implementation2.
The Role of the State in Health Systems
The state's role in health systems is multifaceted, encompassing regulatory, controlling, entrepreneurial, and supervisory functions7. The regulatory function involves developing policies to ensure equitable access to health services, while the controlling function ensures the availability and stability of health service distribution7. The entrepreneurial function allows the state to generate income from health services, which can be used to subsidize care for the underprivileged7. Finally, the supervisory function involves overseeing health facilities to ensure optimal service provision7.
Integrated Health Services: A Model from the U.S. Department of State
The U.S. Department of State's mental health services provide a model for integrated care, offering comprehensive mental health support to U.S. diplomats and their families worldwide4. This program has demonstrated success in delivering high-quality care with low rates of medical evacuation and repatriation, emphasizing the benefits of integrated health services in diverse and challenging environments4.
Health Outcomes and State Spending
Research indicates that states with higher ratios of social to health spending tend to have better health outcomes, including lower rates of obesity, asthma, and mortality from various conditions5. This suggests that investments in social services and public health, alongside healthcare spending, can lead to significant improvements in population health5. Therefore, a broader approach to health investment, encompassing social services, is warranted5.
Health Services in Fragile and Conflict-Affected States
In fragile and conflict-affected states, health service provision is often characterized by a lack of state involvement, leading to a proliferation of diverse, non-state health providers9. These providers fill the gaps left by the state, resulting in a heterogeneous and irregular health service landscape9. Effective engagement with these emergent networks of health providers is crucial for improving health service delivery in such contexts9.
Integrating Health and Social Services
To achieve improved population health, states are increasingly looking to integrate health care, public health, and social services. Essential components for this integration include a coordinating mechanism, quality measurement and data-sharing tools, and aligned financing and payment systems10. A structured policy framework can help states move beyond isolated pilot efforts and establish the necessary infrastructure for ongoing integration, particularly for Medicaid beneficiaries10.
Conclusion
The organization and delivery of state and local health services are complex and varied, influenced by numerous factors including organizational structure, state spending, and the integration of health and social services. Understanding these dynamics is crucial for improving public health performance and health outcomes. Future research and policy efforts should focus on refining organizational categorizations, enhancing integration mechanisms, and effectively engaging non-state health providers, especially in fragile and conflict-affected states.
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Most relevant research papers on this topic
The structure and organization of local and state public health agencies in the U.S.: a systematic review.
Organizational characteristics, such as population size, authority structure, and spending, influence public health performance, but the relationship between organizational characteristics and health outcomes is limited.
Systematic Review
Rigorous Journal
Highly CitedState government organization of health services, 1990-2009: correlates and consequences.
Consolidating Medicaid and public health functions in the same agency does not reduce public health's share of the state budget, but this could change as Medicaid costs continue to grow and the Patient Protection and Affordable Care Act of 2010 is implemented.
Observational StudyThe role of the state in health systems.
The state's role in health systems has evolved over the last decade, with social science contributing to the complexity of the issue through the Welfare State crisis.
The U.S. Department of State's Mental Health Services: A Model for Integrated Care.
The U.S. Department of State's mental health service provides rapid, high-quality care for U.S. diplomats and their families in remote, challenging, and dangerous environments, with low medical evacuation and repatriation rates.
Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.
States with a higher ratio of social to health spending have significantly better health outcomes for adult obesity, asthma, mentally unhealthy days, activity limitations, and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes.
Observational StudyHighly CitedHealth and State Making: The Expansion of State Health Services During the War of Resistance Against Japan (1937–1945)
China's rapid growth in state health services during the War of Resistance against Japan was primarily driven by low-paid medical work of women and an influx of overseas charitable donations.
The Function of the State in Providing Health Services: Indonesia Perspective
The state plays a crucial role in providing health services, ensuring equitable access, maintaining equipment and medicines, and ensuring optimal facility supervision.
THE ROLE OF STATE HEALTH DEPARTMENTS IN MEDICAL CARE.
State health departments play a crucial role in medical care administration and cooperative development of facilities and services with professional, official, and voluntary agencies.
The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states
The "empty void" in health service provision in fragile states is actually a crowded space filled by diverse actors, requiring adaptation, engagement with non-state providers, and support for local capacity and governance.
Observational Study