Public Health Entrepreneurship

1
Public Health Entrepreneurship

• Peter D. Jacobson, JD, MPH
• University of Michigan School of Public Health
• Jeffrey Wasserman, PhD
• RAND Corporation
• Presented to Emerging Findings in PHSSR
• 24 June 2011

2
Project Overview

• Purpose is to describe and classify existing
  public health entrepreneurship (PHE)
• Assess feasibility/desirability of PHE
• PHE defined broadly as generating revenue or
  efficiencies to invest in new services or improve
  financial stability
• Project asks fundamental questions regarding the
  organization and delivery of public health
  services

3
Primary Research Questions

• Activities public entrepreneurs pursue to
  generate new sources of revenue/service delivery
  innovations
• Resulting organizational adaptations
• Population health care case for PHE
• Alternative organizational structures needed to
  facilitate PHE
• Internal and external barriers to change

4
Methods

• Qualitative interviews
• 31 local health departments (LHDs)
• 4 public health institutes (PHIs)
• 3 fiscal sponsor organizations
• 5 health authorities
• 3 port authorities
• 5 major national public health organizations

5
Key Findings Public Health

• Considerable entrepreneurial activity among
  health departments
• Efficiency improvements in clinical services
• Has not generated easily replicable or
  sustainable strategies
• Revenue sources from clinical services, not
  core/essential public health services
• Opportunities include Affordable Care Act
  provisions if fully funded

6
Key Findings Public Health

• Barriers to PHE
• Political constraints
• Civil service constraints
• Budgetary constraints
• Risk-averse culture
• Concern that PHE would undermine core values

7
Key Findings Alternative Organizations

• Dominant PHE activity occurs in PHIs, fiscal
  sponsors, and health authorities
• Avowedly entrepreneurial
• Represent different model for public health
  services
• Common denominator is some form of political
  independence
• Revenue sources primarily back-office support
• Funds leveraged to compete for grants/programs

8
Key Findings Alternative Organizations

• Large cultural gap between health departments
  and other organizational types
• Goal for each is to improve population health
• Fundamentally different approaches core public
  health values vs. entrepreneurial model
• Politicians may balk at ceding political
  control or allocating tax revenue

9
Key Findings Summary

• Fundamental shift may be underway
• PHIs, etc., as vital feature of governmental
  public health
• Competitors vs. collaborators
• Collaboration now dominant, but tension emerging

10
Questions for Public Health Practitioners and
Advocates to Consider

• Is PHE either desirable or necessary to sustain
  governmental public health?
• Which services must remain with government,
  which can be shifted to private sector?
• Are PHIs, etc., temporary solutions to
  short-term fiscal realities, or leading edge of
  disruptive transformation?
• Should/can public health be integrated into
  medical care delivery system without losing core
  values?

11
Recommendations General

• Convene conference to consider above questions
  and develop strategy
• Major national public health organizations
  should collect data about entrepreneurial
  activities and results
• Policymakers need to reconsider the nature of
  political control over public health

12
Recommendations Practitioners

• Rethink relationships to private medical care
  sector
• Examine whether current structure is optimal
  and sustainable
• Study whether entrepreneurial organizations
  provide similar services more efficiently with at
  least equal outcomes as health departments

13
Conclusion

• Population health case for PHE not yet made
• Changes occurring are potentially disruptive
• Pressure on governmental public health to show
  value