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Health Care Manag Sci. 2015 Dec;18(4):475-82. doi: 10.1007/s10729-014-9277-z. Epub 2014 Apr 1.

Public health capacity in the provision of health care services.

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Health Policy and Public Health, University of the Sciences, Philadelphia, PA, 19104, USA.
IESEG, Lille, Paris, France.
University of Rome, Rome, Italy.
Florida Atlantic University, Boca Raton, FL, USA.


In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.


Bootstapping; Capacity utilization; DEA; Public health clinics

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