Variations in the Costs of Delivering Public Health Services: An Analysis of LHDs in Florida

Year: 2013
Funding: Jr Investigator Award
Status: Completed


The costs of delivering public health services vary widely across public health agencies, yet little is known currently about the factors that explain these variations and the changes local health departments (LHDs) could implement to improve their productivity and deliver services more efficiently. The research objective of this study is to investigate characteristics of public health delivery systems that influence the productivity and efficiency with which public health strategies are delivered at the local level.  Financial data for LHDs will be obtained from the Florida Department of Health and supplemented with data on organizational characteristics from NACCHO’s Profile Study and data on community characteristics from the Area Resource File. The sample will include all 67 LHDs in Florida. Descriptive statistics will be used to document variations in LHDs’ productivity and efficiency of service provision, by service line, and to explore changes over time (2001-2010). In a second step, LHD-level multivariate regression analysis using data for the years 2008 and 2010 will be conducted to analyze the factors that determine LHDs’ productivity and efficiency of service provision, by service line. The focus of the analysis will be on factors that LHDs have some control over, including volume, service mix, and staffing decisions.  Given limited financial resources for investments in public health, the project findings will add to the PHSSR evidence base by providing public health practitioners and researchers with an improved understanding of the organizational factors that determine the productivity and efficiency of LHDs and thus the costs these organizations incur in providing public health services. The findings will allow public health officials to implement changes in their organizations aimed at improving the allocation of scarce resources and focus on those investments with the largest effects on population health outcomes.




Simone R. Singh, Ph.D., M.A.


Patrick Bernet, Ph.D., M.B.A.
Florida Atlantic University

Research Area