What could be achieved with greater public hospital autonomy? Comparison of public and PNFP hospitals in Uganda

The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not‐for‐profit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals' performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy. Copyright © 2002 John Wiley & Sons, Ltd.     

Public housing,health, and health behaviors: Is there a connection?

This paper explores the relationship between public housing, health outcomes, and health behaviors among low-income housing residents. While public housing can be a dangerous and unhealthy environment in which to live, the subsidized rent may free up resources for nutritious food and health care. In addition, public housing may be of higher quality than the available alternatives, it may provide easier access to health clinics willing to serve the poor, and it may link residents to social support networks, which can improve mental health and the ability to access higher-quality grocery stores. To test whether there is a "back-door" health benefit to the public housing program, we analyze data from the Fragile Families and Child Wellbeing Study. We minimize the effects of selection into public housing with controls and instrumental variables estimation and find that the results are somewhat sensitive to the instrumental variable used, and thus, we conclude that we are unable to detect a robust health benefit from public housing for our measures of health. However, we do find some evidence that public housing residency has mixed effects on domestic violence, increases obesity, and worsens mothers' overall health status.     

Does the public sector outperform the nonprofit and for‐profit sectors? Evidence from a national panel study on nursing home quality and access

Are public and private organizations fundamentally different? This question has been among the most enduring inquiries in public administration. Our study explores the impact of organizational ownership on two complementary aspects of performance: service quality and access to services for impoverished clients. Derived from public management research on performance determinants and nursing home care literature, our hypotheses stipulate that public, nonprofit, and forprofit nursing homes use different approaches to balance the strategic tradeoff between two aspects of performance. Panel data on 14,423 facilities were analyzed to compare measures of quality and access across three sectors using different estimation methods. Findings indicate that ownership status is associated with critical differences in both quality and access. Public and nonprofit organizations are similar in terms of quality, and both perform significantly better than their forprofit counterparts. When compared to nonprofit and, in some cases, for‐profit facilities, public nursing homes have a significantly higher share of Medicaid recipients. The paper proposes strategies to address the identified long‐term care divide. © 2008 by the Association for Public Policy Analysis and Management.     

ACCESS TO SERVICES: ETHNICITY IN AUSTRALIAN GOVERNMENT ADMINISTRATION

Abstract: This paper starts from an argument, developed by Jean Martin in 1978, which links recent ethnic differentiation of the activities and structures of our major institutions with an underlying social redefinition of migrants. It then extends Martin's analysis in the particular context of the service activities of one of the major line departments of Australian government — the Department of Social Security. It is argued that the accommodation of ethnic considerations within the daily activities of administration has occurred largely through the concept of "access to services". Using this concept, administrators have been able acceptably to define the problem of ethnic disadvantage and to develop programs which approach its solution. The formula has been applied to Aboriginal as well as migrant disadvantage and reasons for the similarity of approach are considered briefly. A range of recent initiatives which make reference to the migrant and Aboriginal clienteles of government are considered — in particular, DSS services, namely language services, migrant and Aboriginal public contact staffing, information services and advocacy/agency programs. All of these are seen within administration, as approaches to the "access" problem. The final section comments on the general characteristics of this "access" formula and on its success in both accommodating ethnic claims of disadvantage and reinforcing administrative commitments to universalism.     

Taken for Granted? Managing for Social Equity in Grant Programs

Managing for social equity performance has long been a goal without much guidance for public managers. We examine social equity performance in the context of indirect governance through the administration of grant programs and, more specifically, the matching of policy responses (grant funding) to social needs. Grant program managers must allocate funding to match needs while also ensuring accountability, but common administrative models that rely on competition can undermine social equity performance. We develop a unique framework to analyze the relative social equity performance of four models of grant administration in general. These models are defined by whether competitions or formulas are used to select grantees and to allocate funding. We test the implications of the framework in an analysis of funding distributions from the nonentitlement Community Development Block Grant program in four states. Our findings suggest that social equity in grant programs is better served when grantors do not rely solely on competitive grant contracting in the selection and distribution of grant funds, which is typical in grant administration. However, policy makers and managers can design institutional arrangements that utilize competition, but in a manner that does not create a bias against more socially equitable funding decisions.     

The Life and Death of UDAG: An Assessment Based on Eight Projects in Five New Jersey Cities

The federal Urban Development Action Grant program, begun in1977, provided $5 billion over eleven years revitalizing severelydistressed urban places through the encouragement of privatesector investment. Designed to assist commercial, industrial,and housing projects that "but for" the federal grant wouldnot be built, the program was characterized by a streamlinedgrant-making process administered by finance and developmentexperts. Eight UDA G projects in five New Jersey cities, firststudied in the proposal stage in 1979 and revisited in 1987,show that the UDAGs succeeded in attracting development to thesehard-pressed cities. Although the projects succeeded, the programwas unable to arrest the more general distressed conditionsof the cities. During the Reagan years, the administration soughtto end the program. Congress supported it, but reduced the fundingeach year. In an effort to gain support for the program, eligibilityrequirements were broadened to include more localities. Theseefforts failed, and in 1988 Congress did not fund the program.Despite its demise, UDAG is recognized as having stimulatedurban revitalization and having created a new model for privatesector and public sector collaboration in economic development.     

The Reformer's Spirit: How Public Administrators Fuel Training in the Skills of Good Governance

The public administration literature has long identified public administrators as key players in achieving government reform. Public managers may be motivated to provide employee access to training in governance skills by several factors, including the need to fulfill the current functions of government, to expand employee responsibilities, or to reform administrative processes and/or programs. The authors examine the impact of public managers on the availability of governance skills training by observing how the desire to achieve reform influences their training decisions in light of other motivating factors. They find that training in citizen input, client relations, and performance indicators are significantly and substantively more prevalent in organizations when public managers believe that such training is necessary for reform, and that the more “democratic” a skill, the more likely a reform motivation will outweigh other factors.     

Professional Cities: Accredited Agencies,Government Structure,and Rational Choice

Accreditation, long used to signal quality among hospitals and universities, has been available to police, fire, and public works departments since the late 1980s. For public service departments, accreditation is a voluntary process that demands significant organizational resources without a guaranteed outcome. Why would city officials devote scarce resources to such an endeavor? Two explanations are examined. First, accreditation may be a rational response to a history of trouble or the potential for future crisis. Second, municipalities may use accreditation to build a reputation for professional administration of public services. The authors use Poisson regression to test these explanations on a new data set of midsize cities .     

Landmark among decision-making and policy analyses and template for integrating alternative frames of reference: Glenn D. Paige,The Korean Decision

That policies and decisions provide distinctive foci for the application of scholarly attention is a hallmark of the last half of the 20th century. Among landmark invocations of such attention was and is Glenn D. Paige's The Korean Decision. Landmarks represent creative achievements that lay down original formulations or findings or point the ways to original findings, and they do so with high quality of method and exposition. The Korean Decision exhibited the first and fullest use of Richard C. Snyder's decision-making approach in the study of public order decisions and it did so in ways that opened new lines of inquiry. It also rendered evident equivalencies with the decision-centered conception of the policy sciences as formulated by Harold D. Lasswell and Myres S. McDougal. This reappraisal of Paige's classic work stresses explicit and implicit complementarities between one decision-making approach and the policy sciences. Several equivalencies illustrate points at which the addition or the overlap of one scheme to and with another may enrich alternative approaches to common phenomena, including observational standpoint, conceptions of the decision process, definition of decisional situations, crisis as a special occasion for decision, linkages among variables, and appraisal as a particular decision process function.     

Good Cuts,Bad Cuts: The Need for Expenditure Analysis in Decremental Budgeting*

Quantitative targets are widely used in decremental budgeting. On the macro-level, governments set global limits for the growth of public expenditures, government deficits, or the ratio of government spending to GNP. On the micro-level, reduction targets are frequently assigned to spending ministries or agencies on a selective basis or across-the-board. While this kind of targetry appears to be indispensable to achieve cutbacks, it is also very deficient in that it treats public expenditures as a fungible commodity, consisting of interchangeable units of account. As austerity policies are coming of age, the inherent weaknesses in the targets approach attract increasing attention, and there is growing concern about the quality of austerity measures. To make sound decisions on such measures, governments must develop a better understanding of the characteristics and properties of various public expenditures. This paper outlines four varieties of expenditure analysis that may contribute to ‘the leap from quantity to quality’ in decremental budgeting.     

Commercialism in nonprofit hospitals

The private nonprofit hospital is the dominant organizational form in the U.S. hospital industry. Various reasons have been advanced for its high market share. As hospitals undergo massive changes due in large part to changes in payment practices, there is widespread concern that nonprofit hospitals may become less committed to noncommercial activities. This may even be more likely when such hospitals convert to for-profit status. The empirical evidence indicates that, on average, hospitals of nonprofit and for-profit ownership are similar in the provision of uncompensated care, the quality of care, and the adoption of technology. Conversion of a nonprofit to for-profit status does not adversely affect the provision of uncompensated care on average. However, for-profits are more likely to be located in areas where consumers have the ability to pay for care. As hospital markets become more competitive and the opportunity for cross-subsidizing more unprofitable, collective-good activities will become increasingly difficult. Support for such activities, if they are to exist, will have to come from explicit public subsidies.     

The Conditions of Care: Reframing the Debate about Public Sector Ethic

While a growing body of research argues for increased attention to ethics within public administration, scholars diverge on how to conceptualize the character of public ethics. Likewise, empirical evidence regarding the role that ethics plays in the quality of service delivery is rare. The author argues that the concept of a public ethics of care is useful for public administration in welfare states. She examines the idea empirically through a large‐N analysis of frontline bureaucrats within the Swedish Social Insurance Administration. The analysis develops two general measures of a public ethics of care as well as a public ethics of justice. The author proceeds to show a clear presence of an ethics of care in the Swedish public sector. Further, analysis shows that these two ethics measures are supplementary, not contradictory, and that age is the main individual determinant behind ethics of care, strongly correlating with number of years in office. The conclusion underscores how public ethics of care results from acquired experience in fulfilling care‐oriented tasks.     

Should the housing voucher program become a state‐administered block grant?

Abstract

The Bush administration has proposed that the current national Housing Choice Voucher Program, which has an essentially uniform program design and is administered largely by local public housing authorities, become a block grant administered by the states. This article examines the potential benefits and hazards of such a change.

While this article does not support or analyze directly the administration's proposal, it concludes that state administration is fundamentally a good idea. However, the choice‐based nature of the voucher program should be preserved, and the early stages of implementation should permit changes to the program's subsidy structure and housing quality inspection only in selected states and with careful evaluation. The law enacting the new program should include clearly articulated goals and mandated reporting requirements. Also, the program should be funded and monitored to maintain the national commitment to meeting the housing needs of low‐income renters.     

Defining the Boundaries of Public Administration: Undisciplined Mongrels versus Disciplined Purists

"Undisciplined mongrels" are faculty from public administration programs who publish in a wide variety of journals. We expected that undisciplined mongrels would have more successful publishing records than their counterparts—"disciplined purists" who publish exclusively in public administration journals. This expectation is supported through an analysis of journal publications by a panel of 91 junior faculty members. We also expected that the methods that are currently used to rank public administration programs would discard a massive body of publication activity by public administration faculty. This expectation is also soundly supported. Findings indicate that from 1990 through 1997, a scant 18 percent of the articles published by the faculty panel were published in the highly selective set of 11 journals that are currently used to rank public administration programs.     

POLITICS, POLICY MAKING AND PRESSURE GROUPS: SOME SUGGESTIONS FOR REFORM OF THE AUSTRALIAN POLITICAL SYSTEM

Abstract: In Australia, current policy making is characterized by immobilism, drift and "pluralistic stagnation". The problem is not lack of technical expertise, but the mobilization of political consent in a polity in which pressure groups have proliferated. In the post-war period, the welfare state/managed economy has transformed the role of government and the potential power of pressure groups. New networks of interdependency have developed. Some of the principal groups are beneficiaries of redistributive programs, producer groups, state and local government agencies and professionals in government. Their potential power has been made actual by a new participative ethic. The post-materialist values of which this is part also result in the growth of groups focusing on quality of life and moral issues. In this context the political parties are losing their central place in the polity and the centralized organs of executive government appear over-secretive and aloof. Reforms are needed to realign institutions with the new cultural and structural realities. Broader interest group involvement is needed. Parliament, through a committee system, could play a major role and its historical function as custodian of the public interest should be revived. Departments must find new ways to involve more groups in policy formulation and implementation. Information must be shared more widely and policy analysts and advisors should work more closely with groups in defining issues, negotiating alternatives and encouraging the development of supportive coalitions. New "intelligence" and "outreach" functions within the public service are required, and the existing approaches of policy units and research bureaux should be remodelled.     

Day care and female employment in Mexico: descriptive evidence and policy considerations

"This paper analyzes the supply and organization of public day care in Mexico and presents a series of considerations as to the formulation of future policy. The research concentrates on the evolution of public policies to provide day care to working women in the formal sector through the Mexican Social Security Institute (IMSS). Data on the evolution of female labor force participation, changes in family structure, the supply of day care and patterns of child care arrangements, suggest that access to formal facilities falls short of demand.... Innovative policies for the reorganization and expansion of the provision of day care are presently under consideration." (EXCERPT)     

Still a poster child for social investment? Changing regulatory dynamics of early childhood education and care in Denmark and Sweden

This paper investigates the regulation of publicly organized early childhood education and care (ECEC) in Denmark and Sweden, through the regulatory welfare state (RWS) framework. The analysis focuses on how alterations in funding and quality of care are shaped by governmental and nongovernmental actors at national and local levels of government. Through focused structured analysis, we examine how various actors have shaped the funding and quality of childcare in Denmark and Sweden, from the early 2000s to 2020, with special attention to the period during and after the 2008 financial crisis. In the aftermath of the financial crisis, concerns about quality in care were raised on the political agenda by various actors in both countries, leading to decisions to improve the quality of care. Yet, the regulatory dynamics differ: In Denmark, the debate led to a decision in 2019, to implement a minimum statutory requirement of regulatory quality standards. From an RWS perspective, this outcome can be qualified as “double expansion,” because regulatory quality standards, and public funding for childcare increased. In Sweden, the debates about quality of ECEC led, in 2016, to political guidelines about quality standard, but with no additional national funds, and no mandatory regulatory quality requirements. Analytically, this can be qualified as “regulatory-led expansion,” that is requirements for quality standards, although the lack of additional national funds suggests that it will be difficult to improve ECEC quality substantially. The RWS perspective, which focuses on national and municipal levels of governance, also gives insights into hidden inequalities between municipalities regarding funding and quality of ECEC, which are more pronounced in Sweden than in Denmark.     

New Labour and Government in Britain: Change or Continuity?

The 1997 British election marks a major change in British government. Eighteen years of Conservative rule had brought about growing inequality and social division and have generated powerful demands for new directions in public policy, especially in the areas of welfare and public administration. On welfare state reform Labour is constrained by election promises to restrain taxation and public expenditure. New Labour ministers influenced by the New Right have in any case largely rejected traditional social democratic redistributive strategies and are seeking instead new ways of reducing welfare dependency.
The virulent spread of quangos at all levels of government and a marked increase in the centralisation of power in Whitehall have given a new impetus to demands for constitutional reform. Labour's response to these demands is a major program of regional devolution, House of Lords reform and open government measures.
This article explains what 'New Labour' means and discusses New Labour policies on welfare and constitutional reform and their implications for the future of public administration in Britain.     

Loyalty or Competence: Political Use of Performance Information and Negativity Bias

This article explores how political principals weigh loyalty and competence in public personnel decisions. Exploiting the abrupt shift in political leadership following the impeachment of President Park Geun‐hye of Korea, the authors examine how the newly elected president made the decision to retain or dismiss 118 agency heads appointed by the previous administration. The evidence shows the importance of loyalty in managerial survival: those who had a political patronage relationship with the ousted president were less likely to survive in the new administration. However, the authors also demonstrate the relevance of competence, as measured by the outcomes of agency performance evaluation. Further, the article shows the existence of negativity bias: the punishment for low performance is greater than the reward for high performance. Finally, the authors provide support for the idea that political principals reward loyalists, but only if they show acceptable levels of competence.