UC Merced

Local Health Departments (LHDs) perform a critical role in providing essential public health services to prevent the spread of disease. National surveys of LHDs from 2008 to 2016 indicate a consistent commitment to providing preventive clinical services such as childhood immunizations, screening and treatment of tuberculosis, and screening and treatment of sexually transmitted disease (STDs). Due to the implementation of the Affordable Care Act in 2010, more people have access to health insurance and preventive services. As more resources are re-directed to community health centers and medical homes, LHDs need to reconsider whether to maintain these preventive clinical services. The challenge for LHDs is the uncertainty about the cost to delivering these services. This dissertation estimates the cost for LHDs to deliver childhood immunizations, screening and treatment of tuberculosis and STDs using resource based costing methods, as well as a community engagement framework to explore barriers in achieving optimal childhood immunization rates. Evidence suggests that while the estimated costs to deliver these preventive clinical services varied widely among LHDs, these costs are comparatively lower than published rates. Evidence also suggests that LHDs in rural counties may experience more barriers in delivering childhood immunization services than their non-rural counterparts. These geographic variations include more rural LHDs reporting lower immunization coverage rates, and experiencing barriers such as lack of timely appointments, high cost to provide immunizations, anti-vaccination concerns, and lack of reimbursement for services from both public and private health insurance providers.