Florida Public Health Review

Publication Date

January 2012


This policy-related study examines primary care delivery methods in reducing population health disparities. We use post- neonatal mortality as an indicator ofpopulation health within counties to study the effects ofusing contracted service providers compared to direct provision of primary care by county health departments in improving health equity. We analyzed post- neonatal mortality data collected annually between 1997 and 2006 from ten ofFlorida’s most populous counties (>500,000). Using Poisson regression analyses with generalized estimating equations (GEE), we examined differences in post-neonatal mortality among racial and ethnic groups; and among counties and groups over time. The results show significant differences in post-neonatal mortality between Black and White groups in both counties that outsource county health department primary care services and also counties that do not outsource these services. After adjusting for low birth weight and age ofthe mother (< 20 years), the post-neonatal mortality rate for black infants remains higher in outsourced counties but not in non- outsourced counties. The increase in disparity in post-neonatal mortality rates between black and white infants in outsourced counties compared to non-outsourced counties is also significant. Contracted service providers are being used with greater frequency to expand access to health services with the idea that they can improve health outcomes; however, these data show that all groups may not benefit equally under this mechanism ofservice delivery.