cials at public health departments, such disease clusters could be reported before a widespread epidemic occurred. Even with the onset of an epidemic, public health officials can take advantage of managed care's cost-effectiveness by contracting with a health plan for the clinical testing and treatment of large numbers of individuals at risk of particular infections.

There are no insurmountable legal obstacles to these activities. Delegation of public health activities raises a constitutional issue only when government power is exercised by a private entity that deprives a person of life, liberty, or power under the behest of the state. Data collection, analysis, reporting, and specimen testing are constitutionally permissible since no significant liberty or property rights are violated. In contrast, monitoring and prevention activities such as contact tracing, mandatory testing, and compulsory quarantine and isolation are constitutionally suspect when performed by the private sector, and therefore, it is important that public health departments retain these functions.


Jonathan R. Davis, Ph.D., Editor

Disease surveillance and monitoring activities are a cornerstone of public health practice. These activities provide information crucial not only for assessment of the status of public health, monitoring of health trends, and recommendation of priorities but also for evaluation of the effectiveness of public health programs. A partnership between public health surveillance activities and managed care systems has many potential benefits since a primary goal of both is the health of a population. However, as identified in the workshop discussions, several impediments must be overcome before surveillance through managed care can be conducted.

Understanding Professional Roles in Surveillance and Monitoring

Relatively few health care providers fully understand the importance of public health surveillance, the role of the provider as a source of data, and the role of public health departments in responding to infectious diseases. The lack of understanding of the health department's role in surveillance may have originated either from the absence of feedback from public health agencies indicating how data are used or from a lack of availability of the data to the public, providers, or potential users of those data. Workshop participants asserted that managed care systems must provide an opportunity for public health agencies not only to explain their roles in surveillance and response but also to establish partnerships as a way of ensuring bilateral communication on cases of infectious diseases and opportunities for preventing the spread of infectious diseases.

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