Privatization and the scope of public health: A national survey of local health department directors

Objectives This study sought to obtain and analyze nationally representativ e data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on p rivatization practices. Methods A stratified representative national sample of 380 local health dep artment directors was drawn, and 347 directors were interviewed by telephon e. Logistic regression established the independent effects of various facto rs on decisions to privatize. Results, Almost three quarters (73%) of the local health departments privat ized public health services of some type. The 12% of the directors who beli eved that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal heal th care were more likely to privatize services. The 77% of the directors wh o believed that local health departments should be involved in an increasin g array of social problems were more likely to privatize. Conclusions. Privatization has quietly and quickly become commonplace in pu blic health, and privatization practices are intimately related to divergen t conceptions of public health and the role of local health departments.