Explaining the efficiency of local health departments in the U.S.: an exploratory analysis
- 303 Downloads
No study to date has analyzed the efficiency at which local health departments (LHDs) produce public health services. As a result, this study employs data envelopment analysis (DEA) to explore the relative technical efficiency of LHDs operating in the United States using 2005 data. The DEA indicates that the typical LHD operates with about 28% inefficiency although inefficiency runs as high as 69% for some LHDs. Multiple regression analysis reveals that more centralized and urban LHDs are less efficient at producing local public health services. The findings also suggest that efficiency is higher for LHDs that produce a greater variety of services internally and rely more on internal funding. However, because this is the first study of LHD efficiency and some shortcomings exist with the available data, we are reluctant to draw strong policy conclusions from the analysis.
KeywordsPublic health Efficiency Data envelopment analysis
We thank Carolyn Leep of the National Association of County and City Health Officers for helping us secure the necessary data. Data for this study were obtained from the 2005 National Profile of Local Public Health Agencies, a project supported through a cooperative agreement between the National Association of County and City Health Officials and the Centers for Disease Control and Prevention. We also thank the anonymous referees of this journal for their helpful comments and suggestions for improving the paper.
- 6.Borcherding TE, Deacon RT (1972) The demands for the services of non-federal governments. Am Econ Rev 62:891–901Google Scholar
- 8.Charnes A, Cooper WW, Rhodes E (1978) Measuring the efficiency of decision making units. Eur J Oper Res 3(4):392–444Google Scholar
- 9.Chilingerian JA, Sherman HD (2004) Health care applications: from hospitals to physicians, from productive efficiency to quality frontiers. In: Cooper WW, Seiford LM, Zhu J (eds) The handbook on data envelopment analysis. Kluwer Academic Publishers, New YorkGoogle Scholar
- 12.Farrell MJ (1957) The measurement of productive efficiency. J R Stat Soc 120(Series A, part 3):253–281Google Scholar
- 15.Greene WH (2007) Econometric analysis. Prentice Hall, Upper Saddle RiverGoogle Scholar
- 20.Koopmans TC (1951) An analysis of production as an efficient combination of activities. In: Koopmans TC (ed) Activity analysis of production and allocation. Cowles commission for research in economics, monograph, no. 13. Wiley, New YorkGoogle Scholar
- 23.National Association of County and City Health Officers (NACCHO) (2006) 2005 National profile of local health departments. NACCHO, WashingtonGoogle Scholar
- 26.Rawding N, Wasserman M (1997) The local health department. In: Scutchfield FD, Keck CE (eds) Principles of public health practice. International Thompson Publishing, Albany, pp 87–100Google Scholar
- 34.Thanassoulis E (2001) Introduction to the theory and application of data envelopment analysis—a foundation text with integrated software. Kluwer Academic Publishers, NorwellGoogle Scholar
- 35.Thanassoulis E, Portela MCS, Despić O (2008) Data envelopment analysis: the mathematical programming approach to efficiency analysis. In: Fried H, Lovell CAK, Schmidt SS (eds) The measurement of productive efficiency and productivity growth. Oxford University Press, pp 251–420Google Scholar