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The Other Invisible Hand
How can we ensure high-quality public services such as health care and education? Governments spend huge amounts of public money on public services such as health, education, and social care, and yet the services that are actually delivered are often low quality, inefficiently run, unresponsive to their users, and inequitable in their distribution. In this book, Julian Le Grand argues that the best solution is to offer choice to users and to encourage competition among providers. Le Grand has just completed a period as policy advisor working within the British government at the highest levels, and from this he has gained evidence to support his earlier theoretical work and has experienced the political reality of putting public policy theory into practice. He examines four ways of delivering public services: trust; targets and performance management; \"voice\"; and choice and competition. He argues that, although all of these have their merits, in most situations policies that rely on extending choice and competition among providers have the most potential for delivering high-quality, efficient, responsive, and equitable services. But it is important that the relevant policies be appropriately designed, and this book provides a detailed discussion of the principal features that these policies should have in the context of health care and education. It concludes with a discussion of the politics of choice.
eBook
Saving America?
On January 29, 2001, President George W. Bush signed an executive order creating the White House Office of Faith-Based and Community Initiatives. This action marked a key step toward institutionalizing an idea that emerged in the mid-1990s under the Clinton administration--the transfer of some social programs from government control to religious organizations. However, despite an increasingly vocal, ideologically charged national debate--a debate centered on such questions as: What are these organizations doing? How well are they doing it? Should they be supported with tax dollars?--solid answers have been few. In Saving America? Robert Wuthnow provides a wealth of up-to-date information whose absence, until now, has hindered the pursuit of answers. Assembling and analyzing new evidence from research he and others have conducted, he reveals what social support faith-based agencies are capable of providing. Among the many questions he addresses: Are congregations effective vehicles for providing broad-based social programs, or are they best at supporting their own members? How many local congregations have formal programs to assist needy families? How much money do such programs represent? How many specialized faith-based service agencies are there, and which are most effective? Are religious organizations promoting trust, love, and compassion? The answers that emerge demonstrate that American religion is helping needy families and that it is, more broadly, fostering civil society. Yet religion alone cannot save America from the broad problems it faces in providing social services to those who need them most. Elegantly written, Saving America? represents an authoritative and evenhanded benchmark of information for the current--and the coming--debate.
eBook
Catching a Case
Influenced by news reports of young children brutalized by their parents, most of us see the role of child services as the prevention of severe physical abuse. But as Tina Lee shows inCatching a Case, most child welfare cases revolve around often ill-founded charges of neglect, and the parents swept into the system are generally struggling but loving, fighting to raise their children in the face of crushing poverty, violent crime, poor housing, lack of childcare, and failing schools.
Lee explored the child welfare system in New York City, observing family courts, interviewing parents and following them through the system, asking caseworkers for descriptions of their work and their decision-making processes, and discussing cases with attorneys on all sides. What she discovered about the system is troubling. Lee reveals that, in the face of draconian budget cuts and a political climate that blames the poor for their own poverty, child welfare practices have become punitive, focused on removing children from their families and on parental compliance with rules. Rather than provide needed help for families, case workers often hold parents to standards almost impossible for working-class and poor parents to meet. For instance, parents can be accused of neglect for providing inadequate childcare or housing even when they cannot afford anything better. In many cases, child welfare exacerbates family problems and sometimes drives parents further into poverty while the family court system does little to protect their rights.
Catching a Caseis a much-needed wake-up call to improve the child welfare system, and to offer more comprehensive social services that will allow all children to thrive.
eBook
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda.
166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics.
Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines.
The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health.
World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
Journal Article
Working with Muslim clients in the helping professions
\"\"This book examines professions that involve working with diverse populations and addresses contemporary issues that impact the full and successful utilization of human services by Muslims living in non-Muslim majority countries\"--Provided by publisher\"-- Provided by publisher.
Book
Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities
ABSTRACT
BACKGROUND
Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors.
OBJECTIVE
To compare the effectiveness of
Community Engagement and Planning (CEP)
and
Resources for Services (RS)
to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use.
DESIGN
Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles.
PARTICIPANTS
From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up.
MEASURES
Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use.
RESULTS
CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each
p
< 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each
p
> 0.05).
CONCLUSION
Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.
Journal Article