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
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
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
Methods
• Qualitative interviews
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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
Key Findings: Public Health
• Considerable entrepreneurial activity among health
departments
o Efficiency improvements in clinical services
o Has not generated easily replicable or sustainable strategies
o Revenue sources from clinical services, not core/essential public
health services
o Opportunities include Affordable Care Act provisions if fully funded
Key Findings: Public Health
• Barriers to PHE
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Political constraints
Civil service constraints
Budgetary constraints
Risk-averse culture
Concern that PHE would undermine core values
Key Findings: Alternative Organizations
• Dominant PHE activity occurs in PHIs, fiscal sponsors, and
health authorities
o Avowedly entrepreneurial
o Represent different model for public health services
o Common denominator is some form of political independence
•Revenue sources primarily back-office support
o Funds leveraged to compete for grants/programs
Key Findings: Alternative Organizations
• Large cultural gap between health departments and other
organizational types
o Goal for each is to improve population health
o Fundamentally different approaches – core public health values vs.
entrepreneurial model
• Politicians may balk at ceding political control or allocating tax
revenue
Key Findings: Summary
• Fundamental shift may be underway
o PHIs, etc., as vital feature of governmental public health
o Competitors vs. collaborators
o Collaboration now dominant, but tension emerging
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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?
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
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
Conclusion
• Population health case for PHE not yet made
• Changes occurring are potentially disruptive
• Pressure on governmental public health to show value