Regionalization of Government Services

Lessons Learned & Application for Public Health Service Delivery

The Robert Wood Johnson Foundation commissioned a study to examine the potential benefits of consolidating public health services in order to reduce costs and increase quality. The project, entitled Regionalization of Government Services: Lessons Learned & Application for Public Health Service Delivery, was led by Nancy J. Kaufman of The Strategic Vision Group. Among its findings are the following:

  • Bigger (or smaller) is not necessarily better—economies of scale diminish in organizations too large and too small.
  • When done correctly, shared services achieves the best of two worlds: the benefits of “mid-sizing” (avoiding consolidation that is either too small or too large) and local control over the bulk of service decisions.
  • While accreditation itself was not usually a factor in consolidation, two of the outcomes of accreditation—saving costs and improving the level and quality of services—were often goals.
  • It takes time to successfully navigate more complex shared services arrangements, and more time still to measure their cost-cutting and quality assurance benefits.
  • In some cases, state statutes and public health regulations may be needed to be revised to advance further innovations in sharing services within and among states.