Evaluation of the public health service law of the German federal state ofSaxony-Anhalt - Community affairs, transfer of power, and loss of control

Aim: In the state of Saxony-Anhalt, a new Public Health Service law came in to force in 1998. Our study investigated whether this new legislation has l ed to an extension of duties performed by regional health departments and t o a subsequent increase in expenditure. Methods: Guided interviews at all administrative levels of the public healt h system were conducted. The catalogue of duties was systematized and a que stionnaire was developed and distributed to all regional health departments (response rate: 17 out of 24). Data concerning revenues and expenditures o f the regional health departments were analysed on the basis of the adminis trative districts' budget data. Results: Regional health departments stated that there had been practically no change in their activities over the last few years. When questioned abo ut the coverage of 58 specific duties, a considerable disparity was evident between departments. A core group of,classical" duties comprising environm ental health and hygiene, child health protection, individual health apprai sal, and public health supervision are carried out on an established basis. Some duties were handled by external institutions, others, mostly communit y health duties, were not performed on an extensive scale. When asked about the desired model for their health department, most departments preferred the model of being an executor of sovereign duties, however a corporate mod el was deemed to be almost as acceptable. The following fields will gain in creasing significance in the future: environmental medicine, health reporti ng, preventive medicine, co-ordination of regional health care, and health promotion. Since 1995, staff has been reduced in all regional health depart ments (-10,4%: 1999: 2.92 employees per 10,000 inhabitants), In 1999, expen ditures amounted to an average of 24.64 German Marks per capita (range 14.2 0-44.58 DM). The number of inhabitants and the revenue of the regional dist ricts were determinants of their health budgets. Conclusion: Our results showed that no uncompensated additional expenditure by regional authorities resulted from this law, So far, most districts hav e not perceived regional health as a community affair offering possible com petitive advantages. The federal state lost considerable influence at the r egional level. Recommended are regional health priorities, conjoint staff d evelopment, and state guidance by a head agency providing leadership and su pport, while leaving responsibility with the districts.