Transformations in public health systems.

Abstract

Public health systems are undergoing major changes. Historically, population-oriented services framed the responsibilities of the public health system. Yet over time, clinical services, particularly maternal and child health care, became an important component. More recently, many public health agencies have begun to refocus on traditional services, largely in response to Medicaid managed care and an associated decline in clients. This paper examines such transformations in thirteen states.