Social Service Reform Research Articles

Contracting and Accountability in State Medicaid Reform: Rhetoric, Theories, and Reality

Introduction Privatization and contracting out have enjoyed widespread popularity in the current climate of government reform. Frequently, privatization and contracting initiatives are pursued because they are consistent with popular political positions. Among the political benefits of privatization is credit claimed by elected officials--including governors for--reforming and shrinking government, thereby reducing taxpayer burdens (Wallin, 1997; Chi, 1993). For administrative leaders, benefits include gubernatorial approval and support (Gill and Rainey, 1998). Yet the rhetoric of capturing market efficiencies through privatization and contracting often masks the reality of administrative shedding and the management challenges that accompany the transition. Recent devolutionary actions, such as the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the enactment of state Medicaid waiver reforms, are likely to expand state contracts with non-government organizations. A significant portion of state services can be categorized as social services, which present unique challenges for privatization and contracting. In the area of social service reform, there is evidence that much of this privatization and contracting activity is plagued by features of the social services market, including an absence of competition among bidders and the subsequent difficulties faced by state contract-management staff. These difficulties include complications in the contracting accountability relationships and changes in organizational cultures that affect the implementation of these reforms (Romzek and Johnston, 1999). While there is a nationwide trend toward privatization, the State of Kansas has taken a national lead in privatizing certain social services, driven primarily by gubernatorial leadership. Early in the current governor's administration, the merits of privatization were regularly featured in media releases and at public political events. Unfortunately, the rhetoric on the benefits of shifting services out of government conflicts with the reality of the contracting environment. Nonetheless, Kansas' privatization/contracting rhetoric has created a trajectory of load shedding. The result has been a continued quest to shift state social services out of government agencies, even as evaluations of such shifts question the cost savings, enhanced quality, and other promised benefits (Fox, et al., 1998). For leaders in the state's social service agency, following this trajectory minimizes political criticism of an organization perceived as large, unwieldy, cumbersome, and ineffective.(1) Political and administrative leaders tend to assume that contract-management and accountability will be relatively straightforward, as will the benefits associated with contracting. We address this assumption by exploring the administrative and accountability dynamics that arise during the implementation of a reform--a reform based on the rhetoric of privatization, but which does not meet the conditions necessary to tap into market relationships. We examine these issues through an in-depth case analysis of a state-level contract for case-management services for elderly Medicaid clients in Kansas.(2) The proliferation of state contracting suggests that there is a legitimate need to study states' capacity to make sound contracting and contract-management decisions. For example, Wallin (1997) indicates the need for more information on state government privatization and contracting activity--especially on the decision processes, which generate such activity. Theories of contracting and accountability provide frameworks within which to examine the market environment and the accountability relationships that characterize this contract. These frameworks provide a basis for considering how rhetoric and theory are manifested in the reality of the contracting experience. Following the lead of Schlesinger et al. …

Reforming Medicaid through Contracting: The Nexus of Implementation and Organizational Culture

This article investigates the administrative experience resulting from the intersection of two popular public management trends: social service reform and contracting out. In this case, the reform involved the state of Kansas contracting with nonprofit agencies to provide Medicaid case management services. Implementation of the reforms entailed substantial changes in the roles and scope of administrative activities for the agencies involved and significant challenges to the administrative cultures of each. As a result, the nonprofit agencies now play a more central role in state policy deliberations and encounter higher levels of interagency political conflict than they did prior to their contracting role. While some of the rationales for the policy reform have been realized, others have been more elusive, including cost savings and the single-point-of-entry organizing principle of the reform. Implementation challenges due to turf issues, tensions over external monitoring, and differences in administrative cultures have contributed to a lack of policy subgroup cohesiveness, which could facilitate intragovernmental and intergovernmental relationships. This article examines the interaction of implementation dynamics and organizational culture in the context of a popular American public policy trend: privatization and contracting. Privatization and contracting have soared in popularity in the last decade and are now finding acceptance in heretofore unimagined arenas, such as prisons and welfare reform.' In the social welfare policy arena, privatization and contracting frequently are manifested in agreements with nonprofits. (Nathan [1997] refers to this phenomenon as nonprofitization.) Research on the subject indicates that contracting presents nonprofits with substantial challenges as they implement new 107/Journal of Public Administration Research and Theory An earlier version of this article was presented at the fourth national Public Management Conference, University of Georgia, Athens, October 1997. The authors are grateful to Denise Casamento and Kara Lindaman for research assistance and to the many state and nonprofit officials who agreed to be interviewed for this study. 'It is important to note that there are inherent differences between privatization and contracting. Privatization implies a more complete transfer of ownership and service delivery from the public to the private sector. Contracting involves government administrative responsibility, with service delivery and/or management provided under a formal agreement with nongovernmental agencies. In our case, the word privatization is used by Kansas elected officials to describe the reform that serves as the focus of our study. In reality, however, the reform entails a new contractual arrangement for service

Beyond ideology: the emerging roles of New Zealand's crown health enterprises.

New Zealand has experienced radical public sector restructuring over the last decade, including the corporatization and subsequent privatization of state trading units and the reform of social services, including health. In 1991 a new government proposed and then implemented more radical health reforms, which included the corporatization of state-owned provider units (23 crown health enterprises) and the creation of an internal market with purchasers (four regional health authorities) separated from providers. Interviews with chief executives of crown health enterprises suggest that provider units are seeking a wider role than envisaged, with an interest in the health needs of their populations and undertaking some purchasing on their behalf. The purchasers see a narrower role for crown health enterprises. Both purchasers and providers report that competition between providers is not particularly helpful (and with only limited opportunities for this to occur), with collaboration being seen as more useful. Providers are critical of purchasers ability to adopt a strategic approach. Unlike other aspects of New Zealand's restructuring, there appears to be a retreat from some of the more radical facets of the reforms, reflecting both the resistance of the health sector and a newly uncertain political climate.

Incrementalism and reform waves: The case of social service reform in the Federal Republic of Germany*

Abstract This article elaborates on the reform of personal social services in the Federal Republic of Germany. It gives an overview of almost five decades of social service reform with a view to substantiating two central claims. First, social service reform in the Federal Republic has now entered a critical stage; both in breadth and depth, current changes are equalled only by the reforms of the late 1960s and early 1970s. These reforms will fundamentally change the German welfare state by transforming the traditional arrangements of service provision. Second, social service reform efforts in the Federal Republic have been characterized by a particular kind of policy cycle. Reforms have not been driven by changes in government, nor have they followed an incremental pattern. Instead, periods of incremental and fragmented reform have alternated with periods of sweeping transformation brought about by fairly broad reform coalitions.

Integrating Services for Children and Families: Understanding the past to Shape the Future

In this comprehensive synthesis of the history, theory, and practice of services integration, Sharon Lynn Kagan, with Peter R. Neville, explores why past efforts to reform the human services system have had only isolated triumphs and marginal impact in improving the quality of life for children and families. Tracing the history of human services in America from the colonial period to the present, Kagan analyzes the underlying assumptions, barriers, and strategies that have characterized the services integration movement and offers new directions for future social service reform.

Enhancing Primary Services for Youth through an Infrastructure of Social Services

This article considers how the strengths of primary social services can be integrated more purposefully into a cohesive, community-based infrastructure of youth andfamily services. The term primary services refers to the wide range of programs and activities that are embedded within the familiar social world of children and their families, and addresses broad developmental outcomes rather than specialized problems. The article first highlights five features of practice and participation that research indicates may distinguish primary social services as a sector and suggests some implications of those features for youth development. The features discussed include a youth development outlook, voluntariness, intentionality, flexibility, and connectedness. It then considers how the benefits of primary services could be amplified by integrating them into a comprehensive, community-based infrastructure of social services. A particular model of infrastructure is reviewed, which poses the primary service sector as both a key ingredient and a beneficiary of this approach to social service reform. The article concludes by suggesting key outcomesfor youth associated with infrastructure reform and highlights research issues involving primary services and infrastructure development.

Building a people's home* for settled, conscientious Swedes

Social policy in Sweden has evolved along two lines, one marginal and the other institutional. A work ethic that stems from the pre‐Christian era is a factor in both these traditions, above all in the marginal model. The marginal line, with social services aimed at the indivual, has traditionally focused on the coercion of deviants, a tendency that was manifest in the statutory provisions up to the reform of the social services in 1982. Rigorous regulations based on domiciliary right meant that poor relief and social assistance were largely reserved for the settled population. A primary aim of the social services reform of 1982 was to replace the existing social relief, with its heavy emphasis on control, by a system of social services that would be voluntary in principle and aimed at catering to the client. Coercive measures became less frequent initially, but the element of repression soon grew again at a time when the economic climate was becoming harsher. Since the beginning of the 1980s there has been a further increase in repression in both social welfare and correctional care. This has been accompanied by significant tendencies to move away from an institutional social policy towards a marginal line. The shifts in values in the 1980s and 1990s do not represent a traditional right‐left dichotomy.

Local Community Services Centers (CLSCs) in Quebec: Description, Evaluation, Perspectives

The health and social services reform of the Canadian Province of Quebec, launched in 1972, has been fairly widely described and evaluated. Such is not the case of the CLSCs (Local Community Services Centers) regarded as the most original institution created in the wake of that reform. This article purports to fill this void by describing to non-Quebecers what CLSCs basically are and do. This seems indicated inasmuch as the network of the Centers represents a some-what unique experience in the Western world. This descriptive and evaluative report is based on a synthesis of the pertinent information and on a series of interviews with “experts” and people in the field. The article describes firstly the nature of the Centers and their place in the health and social services system; it then presents an evaluation of the Centers and outlines a few perspectives fifteen years after their creation. The Centers were from the beginning entrusted with two interconnected missions: the provision of a range of medical and social services, and action on all possible conditions impinging on health and welfare from a local perspective. The article shows that the Centers, in the course of their tormented history, have gone a fair way in fulfilling this dual mission. A recent governmental policy statement confirms that, contrary to the wishes of various conservative circles, the CLSCs are here to stay. It would seem that the CLSCs' experience will continue to be an interesting, real-life health and social laboratory.

Is consumer control possible in health care services? The Quebec case.

In the late 1960s, the Canadian province of Quebec carried out a major reform of its health and social service institutions. As a consequence of the ideology dominating that period, the reform placed great emphasis on citizen participation, establishing local community service centers (centres locaux de services communautaires-CLSC) with boards of directors composed principally of residents of the districts served. This article examines the possible changes brought about by the granting of formal power to health institution consumers. Does this formal power permit citizens to exercise any real control over the institutions? And if so, what does this consumer control modify in terms of the nature, quality, and adaptability of the services offered? Afer a brief description of the Quebec health and social service reform and the resulting CLSCs, this article evaluates consumers' power in these institutions and analyzes the conditions under which such power is exercised. The next section outlines changes that have taken place in the CLSCs, singling out three types of changes for further examination: innovations, adaptations, and transformations. The following section examines the consumers' role in bringing about these changes. On the basis of this analysis, it is possible to conclude that consumer participation is necessary to effect certain types of changes which, otherwise, can deteriorate into bureaucratic processes. The analysis also indicates the existence of diverging and even antagonistic interests between providers (professional employee) and consumers. These contradictions may eventually call into question the classical models of producer self-management.

Coordination and citizen participation.

This study investigates the validity of the assumption that coordination and citizen participation are related inversely and, thus, are incompatible as features in the same social service reform strategy. Seventeen social service organizations situated in the same urban area were studied. Data were obtained by structured interview. The concepts of coordination and citizen participation were operationalized by means of scales. The findings support the validity of the assumption noted above. Although interpretations of the findings can be provided, they are post-factum. This implies a need for explanatory research which might be guided by theories of community power structure and of organizational behavior.

Social Service and Social Reform: A Historical Essay

Social Service and Social Reform: A Historical Essay

The Social Worker in a World of Stress

Previous articleNext article No AccessThe Social Worker in a World of StressCharlotte G. BabcockCharlotte G. Babcock Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Social Service Review Volume 25, Number 1Mar., 1951 Article DOIhttps://doi.org/10.1086/638117 Views: 1Total views on this site Citations: 1Citations are reported from Crossref PDF download Crossref reports the following articles citing this article: Clarke A. Chambers Social Service and Social Reform: A Historical Essay, Social Service Review 37, no.11 (Sep 2015): 76–90.https://doi.org/10.1086/641381