Perceived outcomes of public health privatization: A national survey of local health department directors

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized servic es reported cost savings and half reported that privatization had facilitat ed their performance of the core public health functions. Expanded access t o services was the most commonly reported positive outcome. Of those privat izing, over two-fifths of LHDs reported a resulting increase in time devote d to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disea se seri ices was cited most often as a service that should not: be privatiz ed. There is a pervasive concern that by contracting out services, health d epartments can lose the capacity to respond to disease outbreaks and other crises.