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Christopher Keane, ScD, John Marx, PhD, Edmund Ricci, PhD and Gerald Barron, MPH

Christopher Keane, Edmund Ricci, and John Marx are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa. John Marx is also with the Department of Sociology, University of Pittsburgh. Gerald Barron is with the Allegheny County Health Department, Pittsburgh, Pa.

Correspondence: Requests for reprints should be sent to Christopher Keane, ScD, 211 Parran Hall, 130 DeSoto St, Pittsburgh, PA 15261 (e-mail: crkcity{at}pitt.edu).

Objectives. This article presents nationally representative data on the effects of privatization on local health departments (LHDs).

Methods. A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors.

Results. One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services.

Conclusions. Privatization is part of a broader shift toward "managing" rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services. (Am J Public Health. 2002;92:1178–1180)

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