Managerial and professional beliefs influencing public health privatization: results of a national survey of local health department directors

This article describes managerial and professional beliefs underlying decisions to privatize public health services. We drew a stratified, nationally representative sample of local health departments and interviewed 347 department directors by telephone. We used logistic regression to establish the independent effects of various beliefs on the decision to privatize. Over half of directors did not believe that there was valid evidence that privatization results in more efficient performance, and those who believed there was such evidence were not more likely to privatize. However, directors held professional and managerial beliefs that influenced their decision to privatize. Directors most likely to privatize were those who believed that local health departments should exclusively focus on the core public health functions, those who asserted that public health should become involved in an increasingly diverse array of social problems, and those who believed that employees should be used on a temporary and contractual, rather than permanent, basis wherever possible.