Lantz Paula M, Alexander Jeffrey A, Adolph Christopher, Montgomery Jolynn P
Department of Health Policy, School of Public Health and Health Services at George Washington University, Washington (Dr Lantz); Department of Health Management and Policy (Dr Alexander) and Department of Epidemiology (Dr Montgomery), School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Political Science, and Statistics, and Center for Statistics and the Social Sciences, University of Washington (Dr Adolph).
J Public Health Manag Pract. 2014 Mar-Apr;20(2):160-7. doi: 10.1097/PHH.0b013e31829ff709.
To describe changes in the organizational structure of state health-related departments/agencies between 1990 and 2009; to identify factors associated with key organizational structures; and to investigate their relationship with different resource allocations across health policy areas, as represented by state budgets.
Original data collection on the organization of state health-related departments/agencies from 1990 to 2009. Analyses included descriptive statistics, logistic regression, and time-series regression modeling.
All 50 states.
Organizational structure of state government related to health in 4 areas (Medicaid, public health, mental health, human services); coupling of Medicaid and public health in the same agency; state budget changes in health policy areas, including Medicaid, public health, and hospitals.
The housing of 2 or more health-related functions in the same unit was common, with 21 states combining public health and Medicaid at 1 or more points in time. Eighteen states (36%) reorganized their health agencies/departments during the study period. Controlling for numerous economic, social, and political factors, when the state agency responsible for public health is consolidated with Medicaid, the share of the state budget allocated to Medicaid declined significantly, while public health allocations were unchanged. However, consolidating Medicaid with other services did not impact state Medicaid spending.
Government organizational structure related to health varies greatly across states and is somewhat dynamic. When Medicaid and public health functions are consolidated in the same stage agency, public health does not "lose" in terms of its share of the state budget. However, this could change as Medicaid costs continue to grow and with the implementation the Patient Protection and Affordable Care Act of 2010.
描述1990年至2009年间各州卫生相关部门/机构的组织结构变化；确定与关键组织结构相关的因素；并调查它们与各州预算所代表的不同卫生政策领域资源分配的关系。
对1990年至2009年间各州卫生相关部门/机构的组织情况进行原始数据收集。分析包括描述性统计、逻辑回归和时间序列回归建模。
美国所有50个州。
州政府在4个领域（医疗补助、公共卫生、心理健康、公共服务）与卫生相关的组织结构；医疗补助和公共卫生在同一机构中的合并情况；卫生政策领域的州预算变化，包括医疗补助、公共卫生和医院。
在同一单位内合并两项或更多卫生相关职能的情况很常见，有21个州在某个时间点将公共卫生和医疗补助合并。在研究期间，18个州（36%）对其卫生机构/部门进行了重组。在控制了众多经济、社会和政治因素后，当负责公共卫生的州机构与医疗补助合并时，分配给医疗补助的州预算份额显著下降，而公共卫生拨款不变。然而，将医疗补助与其他服务合并并未影响州医疗补助支出。
各州与卫生相关的政府组织结构差异很大且有所变化。当医疗补助和公共卫生职能在同一州级机构中合并时，公共卫生在州预算中的份额不会“减少”。然而，随着医疗补助成本的持续增长以及2010年《患者保护与平价医疗法案》的实施，这种情况可能会改变。
