Home Care Service Delivery: Proprietary Versus Non-Proprietary Organizations
Hughes, Bette Hill
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https://hdl.handle.net/2142/69805
Description
Title
Home Care Service Delivery: Proprietary Versus Non-Proprietary Organizations
Author(s)
Hughes, Bette Hill
Issue Date
1983
Department of Study
Political Science
Discipline
Political Science
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
Political Science, General
Abstract
This research addresses the comparative effectiveness of a market mechanism. Is it superior to a government/voluntary mechanism in the delivery of community-based social services? The proprietary organizations examined reflect the assumptions of a market mechanism while the non-proprietary organizations operate under the assumptions of a government/voluntary mechanism. These two contrasting mechanisms for implementing social services were derived from the assumptions of two ideal-types in democratic theory regarding differences in administrative strategy and organizational motives. Organization theory suggested four dimensions of organizational effectiveness for evaluating these two mechanisms of service delivery. Each mechanism and its related organization type was hypothesized to maximized different dimensions of organizational effectiveness. Market mechanisms have greater adaptability and efficiency; government/voluntary mechanisms have greater quality of services and quality of the work environment.
The Illinois Community Care Program in FY81 was chosen as an appropriate "laboratory" to examine these issues because it had a state-wide general eligibility program and during its first full year of implementation was highly decentralized with a large amount of program control left to the vendors. Both quantitative and qualitative data sources were employed; the former included client, worker, and vendor level data and the latter involved interviews with twelve selected vendors across the state.
Non-proprietary organizations provided a higher quality of service and a more professional work environment. These agencies were more able to coordinate client services and provide professional for home care workers. The proprietary organizations appeared far more adaptable than the non-profit agencies, taking quick advantage of new market opportunities and exhibiting flexibility to responding to previously unmet needs. A majority of these agencies received pre-screened clients which helped reduce overhead costs and increase the number of seriously disabled clientele being served by them. The proprietaries were more efficient in keeping their actual cost per service unit low. The cost to the state was significantly higher because they provided far more service units than would be explained by client disability, race, or geographic location alone. Such profiteering must be controlled by more careful state monitoring and standards setting.
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