Health Care System Transformation and Integration: A Call to Action for Public Health.

Restructured health care reimbursement systems and new requirements for nonprofit hospitals are transforming the U.S. health system, creating opportunities for enhanced integration of public health and health care goals. This article explores the role of public health practitioners and lawyers in this moment of transformation. We argue that the population perspective and structural strategies that characterize public health can add value to the health care system but could get lost in translation as changes to tax requirements and payment systems are rapidly implemented. We urge public health leaders to take a more active role in hospital assessments of community health needs and evaluation of the patient outcomes for which providers are accountable.

Comparing types of local public health agencies in North Carolina.

CONTEXT: Some states are considering restructuring local public health agencies (LPHAs) in hopes of achieving long-term efficiencies. North Carolina's experience operating different types of LPHAs, such as county health departments, district health departments, public health authorities, and consolidated human services agencies, can provide valuable information to policy makers in other states who are examining how best to organize their local public health system. OBJECTIVE: To identify stakeholders' perceptions of the benefits and challenges associated with different types of LPHAs in North Carolina and to compare LPHA types on selected financial, workforce, and service delivery measures. DESIGN: Focus groups and key informant interviews were conducted to identify stakeholders' perceptions of different LPHA types. To compare LPHA types on finance, workforce, and service delivery measures, descriptive statistical analyses were performed on publicly available quantitative data. SETTING: North Carolina. PARTICIPANTS: Current and former state and local public health practitioners, county commissioners, county managers, assistant managers, state legislators, and others. MAIN OUTCOME MEASURE: In addition to identifying stakeholders' perceptions of LPHA types, proportion of total expenditures by funding source, expenditures per capita by funding source, full-time equivalents per 1000 population, and percentage of 127 tracked services offered were calculated. RESULTS: Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ with regard to source of funding, with county health departments and consolidated human services agencies receiving a greater percentage of their funding from county appropriations than districts and authorities, which receive a comparatively larger percentage from other revenues. CONCLUSION: Types of LPHAs are not entirely distinct from one another, and LPHAs of the same type can vary greatly from one another. However, stakeholders noted differences between LPHA types-particularly with regard to district health departments-that were corroborated by an examination of expenditures per capita and full-time equivalents per 1000 population.

Legal frameworks supporting public health department accreditation: lessons learned from 10 states.

CONTEXT: The existence of different types of accreditation legal frameworks, embedded in complex and varying state legal infrastructures and political environments, raises important legal implications for the national voluntary accreditation program. OBJECTIVE: To increase an understanding of accreditation-enabling laws nationwide. DESIGN: In 2010 to 2011, the North Carolina Institute for Public Health conducted a study of state legal frameworks supporting public health department accreditation or related programs (ie, certification/assessment, performance management, and quality improvement). First, a mapping study was conducted to identify current programs and their legal frameworks. Ten states were then selected for in-depth qualitative case study. Data were gathered through semistructured interviews with public health practitioners and key stakeholders. RESULTS: The findings from the mapping study delineate the accreditation, certification/assessment, performance management, or quality improvement program currently in place and the type of legal framework supporting it. The citations for statutes and regulations are also included. Among the 18 states in the sample, 4 have accreditation programs, 6 have certification/assessment programs, and 8 have performance management/quality improvement programs. Accreditation programs were most likely to have a statutory basis, while performance management and quality improvement programs were most often supported via health department policy. The findings from the case study provide greater detail about each state, reflecting public health structures, programs, legal frameworks, approaches to Public Health Accreditation Board (PHAB) accreditation, and legal strategies for achieving accreditation. CONCLUSIONS: Early adopter states have pursued a variety of legal frameworks to develop their accreditation, certification/assessment, performance management, and quality improvement programs. With the voluntary national accreditation program scheduled to go live in late 2011, these 10 states have also carefully considered options for aligning their activities with PHAB accreditation. Lessons derived from this examination can inform public health practitioners, advocates, and elected officials about how to best structure legal frameworks to support accreditation and related activities.

Informational privacy, public health, and state laws.

Developments in information technology that make it possible to rapidly transmit health information also raise questions about the possible inappropriate use and protection of identifiable (or potentially identifiable) personal health information. Despite efforts to improve state laws, adoption of provisions has lagged. We found that half of states have no statutes addressing nondisclosure of personally identifiable health information generally held by public health agencies. Exceptional treatment of HIV, sexually transmitted infections, or tuberculosis-related information was common. Where other provisions were found, there was little consistency in the laws across states. The variation in state laws supports the need to build consensus on the appropriate use and disclosure of public health information among public health practitioners.