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Local Health Departments in a Managed Care Environment

State-level Initiatives as a Context

Overview of Selected States' Policy Directions

Presenters:

Anne Barry, M.P.H., J.D., Commissioner of Health, Minnesota Department of Health, St. Paul, MN.

Mimi Fields, M.D., M.P.H., F.A.C.P.M., Deputy Secretary/Health Officer, Washington State Department of Health, Olympia, WA.


Minnesota

An important factor influencing the specific roles and activities that individual LHDs may pursue in a managed care environment is the public health policy that is established at the State level.

In Minnesota, the State Health Department has worked hard to promote a vision of the State's evolving health care system as one that focuses on improving the health of the State's population by building upon the complementary strengths of the public and private sectors. This message is reflected in State policies, such as statutes establishing community health boards and requiring managed care organizations to provide information about how they will contribute to community-wide public health efforts.

In addition, this message is clear in the initiatives that the Health Department leads around the development of public health goals, specific strategies and action plans and the promotion of community partnerships.

Washington

In Washington State, recent efforts to redefine the role of local health agencies first developed in the context of the State's passage in 1993 of sweeping health care reform legislation that included provisions for universal coverage. In that context, the State Health Department initiated the Public Health Improvement Program, designed to provide guidance to public health agencies in identifying the most effective roles for them to play in carrying out their core public health functions.

The State has also played a leadership role in its efforts to provide more flexible funding to LHDs and to promote the development of community partnerships. While Washington State has encouraged local health departments (LHDs) to think creatively and act collaboratively with respect to ways to fulfill their assessment, policy development, and assurance functions, many have reduced or eliminated their involvement in the delivery of personal health services. However, with the repeal of much of the State's health care reform legislation, including the requirement for universal coverage, the issue of how to ensure that the needs of the uninsured are met remains a challenge.

References

Collaboration Plans: Looking Toward the Future. Minnesota Department of Health, Community Health Services Division, April 1996.

Developing Partnerships to Improve Public Health. A Report by the State Community Health Services Advisory Committee, December 1996.

Health System Changes. Public Health Improvement Plan, Draft for Steering Committee Review, November 4, 1996.

The 1993 and 1995 Washington State Legislative Sessions: Implications for Public Health at the Local Level.

Competency Model, Office of the Secretary, Washington State Department of Health, Fall 1996.


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