Kent State’s Center for Public Policy finds trend in health care consolidation

Emily Mills

In Ohio, county health departments are absorbing many city agencies, a new study has found.

Kent State’s Center for Public Policy and Health and the University of Arkansas for Medical Sciences recently released the study, “Consolidation of Local Health Departments in Ohio: Motivations and Impacts,” about the trend in Ohio over the last several years.

John Hoornbeek, associate professor in the College of Public Health, director of the Center for Public Policy and Health and principal investigator for the study, said much of the merging, or consolidation ,stems from a lack of money.

“There’s been a lot of discussion in Ohio and throughout the country about ways local governments can work together,” he said. “There have been many cuts in federal aid to health departments in recent years.”

Matthew Stefanak, former Mahoning County health commissioner and co-author of the study, said small, local health departments are often forced to phase into other departments.

“Local governments are under a lot of pressure,” he said. “You get bigger or you get out.”

However, Hoornbeek said there is a bright side as these cuts have forced health departments to deliver the same health services a more efficient manner.

He said consolidation also means improving health departments’ chance at accreditation, which is difficult for small departments to achieve on their own because it requires an array of services they don’t have funds for.

Since 2001, 20 health departments have consolidated in Ohio, according to the study. Nineteen of these consolidations have been city departments consolidating into county health departments. One consolidation was a city health department merging into another city health department.

Stefanak brought the idea for the study to Hoornbeek in early 2012 after he found little information about local health department consolidation.

“There was very little literature on the costs and benefits of consolidation,” he said. “We really couldn’t muster data on frequently asked questions” about the topic.

The two collaborated with Josh Filla, an outreach coordinator for the Center for Public Policy and Health, and Michael Morris, a professor at the University of Arkansas for Medical Sciences. Both are co-authors of the study.

The study was funded by a grant from the Robert Wood Johnson Foundation’s Practice Based Research Network at the University of Kentucky, the world’s largest health-care philanthropy organization, according to its website. It was released Sept. 16 and included a combination of interviews with health department personnel and statistical analyses about what happened after consolidation.

The interviews and statistics both had similar findings.

“Spending and expenditures did go down post-consolidation,” Hoornbeek said.

However, Stefanak said, expenditures did not decrease for both the cities and counties involved in the consolidations.

“We didn’t find any hard evidence that (the counties) cut overhead costs,” he said. “However, we did find the cities saved money.”

In fact, Hoornbeek said, there were decreases in revenue for the first two years, which he called the transitional period.

However, when it came to long-term effects, Hoornbeek said the health department officials who were interviewed agreed consolidation accomplished its two goals: cost-cutting and service improvements.

Hoornbeek, Stefanak and Morris will present their research at the American Public Health Association Conference in Boston on Nov. 2 through 6.

Contact Emily Mills at [email protected].