This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Local Health Departments in a Managed Care Environment
State-level Initiatives as a Context
Overview of Selected States' Policy Directions
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.
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.
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
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
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
Competency Model, Office of the Secretary, Washington State Department of Health, Fall 1996.
Previous Section Contents