Contracting Out and Its Outcomes in Public Health: A Case of New York Counties

• Published date: 01 October 2023
• DOI: http://doi.org/10.1177/02750740231185844
• Author: Shihyun Noh,Ji Hyung Park
• Date: 01 October 2023
• Subject Matter: Articles

Contracting Out and Its Outcomes in

Public Health: A Case of New York

Counties

Shihyun Noh

1

and Ji Hyung Park

2

Abstract

Previous studies have reported a positive relationship between local government spending and health outcomes. However,

there is limited scholarly research on how the different policy tools used for delivering public health services affect the health

of local residents. This study adopted a comprehensive model, widely utilized in health policy and management research, to

control for health behaviors, socioeconomic factors, physical environment, and clinical care. It provides evidence that a county

with higher health spending through contracting has a higher health ranking among New York counties, indicating that service

provision arrangements affect health outcomes. Thus, county efforts to improve health outcomes should consider the effects

of differing service delivery arrangements.

Keywords

contracting out, health outcomes, local government, public health

Introduction

Contracting out has been widely adopted and implemented as

an alternative service arrangement to provide public services

in local governments. Practitioners report that cost-saving

and f‌iscal constraints are primarily related to local govern-

ment service delivery choices (ICMA, 2012, 2017). Studies

on contracting out have been focused on the factors affecting

the decisions (e.g., Bel & Fageda, 2007, 2017; Carr et al.,

2008; Hefetz et al., 2014) and its impacts on cost-saving

and eff‌iciency (e.g., Bel & Warner, 2008; Bel et al., 2010;

Lindholst et al., 2018).

However, several research areas require further investiga-

tion, such as the inadequate emphasis on policy outcomes

and the omission of a comprehensive policy outcome

model when investigating the impacts of contracting out.

First, few studies have paid attention to how contracting

out is related to policy outcomes (Hodge, 2000; Petersen

et al., 2018) even though “outcome is the most important

measure of quality as it relates to the actual impact”

(Petersen et al., 2018, p. 151). Implementing public policies

is a core responsibility of public administration, and, in doing

so, all levels of the government are charged with an effective

and eff‌icient implementation of public programs (Kettl,

2016). To understand the impacts of contracting in the

public administration domain, it is inevitable for researchers

to examine how this policy tool contributes to policy out-

comes, or “actual impact of policy outputs”according to

Mazmanian and Sabatier (1989), beyond the costs and

levels of services provided through contracting. Therefore,

our study focuses on how contracting out expenditures

impact policy outcomes, specif‌ically in the context of

health services in New York counties.

Previous studies on the relationship between contracting

out and outcomes (e.g., O’Toole & Meier, 2004; Rho,

2013) have not fully considered a comprehensive model to

explain the outcomes, potentially leading to biased f‌indings.

In contrast, our research refers to the holistic model that has

been used in recent nationwide studies (e.g., Mays & Smith,

2011; McCullough & Leider, 2016; Singh, 2014). Using the

2014 County Health Ranking model, we have constructed a

comprehensive policy outcome model that includes contract-

ing out health expenditures, health quality indices, health

behaviors, clinical care, social and economic factors, and

physical environment.

Our study investigates the effects of contracting on health

outcomes, offering practical insight into local government

management. As stated earlier, contracting out is a popular

1

Department of Public Administration, SUNY Brockport, Rochester, NY,

USA

2

Departmentof Public Administration, Soongsil University, Dongjak-gu, Seoul,

Korea ( the Re publ ic of)

Corresponding Author:

Ji Hyung Park, Public Administration Department of Public Administration,

Soongsil University, Dongjak-gu, Seoul, Korea (the Republic of).

Email: jihyungpark0819@gmail.com

Article

American Review of Public Administration

2023, Vol. 53(7-8) 347–358

© The Author(s) 2023

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DOI: 10.1177/02750740231185844

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