The relative effect of unionization and interjurisdictional competition on municipal wages

This study analyzes the effect on municipal employee wages of interjurisdictional competition in municipal service markets. The impact of market conditions are analyzed utilizing a bureaucracy model of local governmental decision making. The study develops hypotheses concerning the degree of competition in this market, constructs empirical measures of competition, and investigates the relationship between competition and wage levels for three categories of municipal workers. The empirical results suggest that local market conditions may be as important a determinant of local wages as local labor market conditions, including union membership. Also, the wage effect of unionization appears to be greater in less competitive local government environments. Financial support from the Earhart Foundation is gratefully acknowledged. We would also like to thank Werner Hirsch, Roger Folsom, and Geoffrey Nunn for helpful comments.     

Dangers of Decentralisation in Urban Slums: A Comparative Study of Water Supply and Drainage Service Delivery in Kolkata,India

Clientelism may lead to the underprovision of services which are deemed suitable for decentralisation. Water distribution and drainage services, managed from a lower level of municipal authority, are liable to be affected by clientelism and consequent underprovision. Water quality, maintained from a higher municipal layer, is not likely to be affected by clientelism. Capture by politically influential and dominant social and religious groups is likely to take place for important services like water supply. The article suggests that awareness, measurability, importance and resource intensiveness of service are additional factors to be considered for assessing the suitability of a sector for decentralisation.     

An approach to learning about social work with people with disabilities

The author shares some practice experience and personal reflection on her introduction to working with people with disabilities. Recognizing that the construct of "disability" is in the eye of the beholder, she shares an outline for one approach to an introductory course in working with people with physical, cognitive and developmental, and psychiatric disabilities. Common themes in practice and service delivery are discussed, as well as the unique role social workers can play in interagency collaboration.     

People as partners: Facilitating people's participation in public–private partnerships for solid waste management

Cities in developing countries are facing a double dilemma. On one hand, the urban population is growing rapidly, causing a huge increase in demand for waste management services. On the other hand, the traditional public sector is failing to respond to the increased demand for service. The public sector is constrained by resource and institutional limitations. It is often proposed that the solution lies in private sector participation. It is expected that the private sector, with its dynamism and flexibility, may fill in the service delivery gaps by forming partnership with the public sector. However, a third tier—the people—is often overlooked in the service delivery framework. Citizens can contribute significantly to service delivery. They can support the private sector with payment of service charges. But more importantly, they can play an active role in improving accountability and service quality of both public and private sector. This radical shift in people's role, from passive service receivers to active service partners, however, may not occur endogenously. External help from facilitating agencies may enable the public and private sector to form partnership with people for better service delivery. This article examines the role of facilitating agencies in developing tripartite partnership for solid waste management service in Bangladesh. The key lessons learned are: a number of obstacles prevented spontaneous partnership among the public sector, private sector and people; facilitating agencies were able to overcome the obstacles to form partnership of the three; and, the tripartite arrangement resulted in higher accountability and better service delivery.     

Survey of state vocational rehabilitation counselor roles and competencies in assistive technology

The delivery of assistive technology (AT) within the state and federal vocational rehabilitation systems in the United States has been developing and refining itself over the last twenty years. Many challenges have been confronted in an attempt to use this relatively new service to increase the employment options and success for individuals with disabilities. In this process, the rehabilitation counselor serves as a critical player in the planning and delivery of AT as it articulates with other rehabilitation services. This study investigated counselor views regarding their role and competence in providing AT services and devices to individuals with disabilities throughout the state of Wisconsin. The results of the survey indicated, in general, that counselors find AT to be a cost-effective service that can increase employment related outcomes. As with other service areas, the counselors' role in AT service delivery involves coordinating, purchasing and following up on services. Interestingly, while counselors expressed confidence in performing these overall functions, they reported a lack of confidence in identifying the need for AT services. Without a comfort level to make this determination, benefits from the implementation of AT may be quite limited. Results suggest that intervention is needed to improve counselors' abilities to make decisions regarding AT services.     

The Older Americans Act: should participants share in the cost of services?

Since its inception in 1965, the Older Americans Act has provided social services free of charge to older people, regardless of income. In recent years, the scarcity of resources has sparked a debate as to whether participants who can afford to pay for services should be required to do so. Of concern is whether charging fees will change the fundamental nature of these popular programs by imparting a "welfare" stigma. Other programs that require fees vary enormously by state, and there has been little documentation of their impact on participation, equity of service delivery, or public attitudes. In order to evaluate current proposals, it is necessary to analyze the distributional effects of the cost-sharing system, how the program will be administered, what impact it will have on service use, which services would be subject to cost sharing and at what income levels, and what constitutes a "reasonable" fee for service.     

The Older Americans Act

Since its inception in 1965, the Older Americans Act has provided social services free of charge to older people, regardless of income. In recent years, the scarcity of resources has sparked a debate as to whether participants who can afford to pay for services should be required to do so. Of concern is whether charging fees will change the fundamental nature of these popular programs by imparting a "welfare" stigma Other programs that require fees vary enormously by state, and there has been little documentation of their impact on participation, equity of service delivery, or public attitudes. In order to evaluate current proposals, it is necessary to analyze the distributional effects of the cost-sharing system, how the program will be administered, what impact it will have on service use, which services would be subject to cost sharing and at what income levels, and what constitutes a "reasonable" fee for service.     

Measurement and determinants of efficiency in the municipal police service

The purpose of this paper is to analyze the efficiency of the police service in Spanish municipalities with a population of more than 50,000 inhabitants. Using Data Envelopment Analysis, we obtain the efficiency levels and the targets that the input and outputs have to reach to be efficient in the provision of the police service. Next, and based on the literature, the effect of the following environmental variables is verified: young population, number of foreigners, unemployment, municipal per capita income, tourist level of the municipality, and ideology and political strength of the municipal government. Findings show that an increase in the number of young people in the municipality means an improved efficiency in the local police service. In contrast, cultural diversity (measured by the percentage of foreigners in the total population), unemployment, the mayor's ideology and political fragmentation of government do not have a significant effect on the level of efficiency. On the other hand, higher municipal per capita income means less efficiency, while an increase in tourism activity is related to the improvement of this.     

Parent–Caregiver Experiences With the Autism Spectrum Disorder Service Delivery System

Autism spectrum disorder (ASD) diagnoses are increasing, leading to growing demands on the service delivery system to meet the needs of children and families. Further understanding individual enabling components such as perceptions of parents/caregivers and personnel, as well as community-level enabling components such as the availability of and quality of services, may help inform system improvements. In this qualitative study, 19 parents/caregivers of children with ASD in one state in the United States were interviewed regarding their experiences with the ASD service delivery system, as well as their individual responses in relation to these experiences. Emergent themes point to the importance of individual coping strategies such as social support, collaboration with service providers, advocacy and empowerment, determination, and luck. Characteristics of the service delivery system, positive and negative, also were described. Findings can inform the design of future programs, services, and policies to support parent/caregiver coping and improved service delivery.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

Co-production and Service Quality: The Case of Cooperative Childcare in Sweden

This article compares results from a study of service quality in cooperative and municipal preschools. The parent cooperative and municipal childcare represents two different schools of thought with regard to service quality. The municipal services have a strong tradition of professionalism in which user participation is not allowed to interfere with the qualified work performed by trained professionals. The parent cooperatives have another tradition in which service quality is developed in a dialogue between users and staff while they co-produce the services together. The former tradition is the dominant one in the Swedish welfare state while the latter is an exception. The conclusion of the article is that service quality is better in the parent cooperative childcare in spite of the widespread assumption in Sweden that service quality is close to synonymous with professionalism.     

Helping Oneself by Helping Others: Evaluation of a Service Credit Banking Demonstration

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.     

Helping oneself by helping others: evaluation of a service credit banking demonstration

Between 1987 and 1990, the Robert Wood Johnson Foundation funded six service credit banking demonstration programs among the elderly in which participants delivered services in return for credits, entitling them to later service. This evaluation of the demonstrations found that these six sites successfully attracted elders for the delivery of household support services to a relatively old, frail population with potentially limited social networks. Evidence on the significance of the "credit" in attracting volunteers was mixed, but the programs have attracted new volunteers, and have not substituted for other volunteer activities. Program development has entailed considerable staff investment in volunteer support; programs are better understood as community membership organizations than as mechanical exchanges.     

The LivePerson Model for Delivery of Etherapy Services: A Case Study

ABSTRACT

There are several models for the delivery of etherapy on the Internet. This article presents a case study of one model, the LivePerson website. The model is based on a privately owned infrastructure through which etherapy is practiced by licensed counselors using chat or e-mail for service delivery. A content analysis of the website is presented, including policies, number of consumers, consumer ratings, and therapists’ degrees, licensure, age, sex, race, fees, and languages offered. In addition, the experiences of one LivePerson practitioner are presented to highlight methods, processes, and ethical concerns. This case study of the LivePerson model for service delivery highlights many of the benefits and concerns previously discussed in the literature related to etherapy. In addition, concerns are raised that there may be some conflict of interest when ethical standards of practice are delivered within the context of a profit-making company.     

ESTIMATING TELEPHONE NONCOVERAGE BIAS WITH A TELEPHONE SURVEY

Nontelephone households are implicitly treated as a static populationin discussions of sampling frame noncoverage. Yet telephoneservice is known to be episodic for many households, who maygain or lose service as their financial situation changes orwhen they move. Thus the population of telephone householdsat any given time includes households that were recently a partof the nontelephone population. These households may be usedto characterize the nature of some noncoverage errors and evento estimate their magnitude. Using a panel constructed withthe 1992-93 Current Population Survey, "transient" telephonehouseholds-those who gained or lost service over the year coveredby the panel-are shown to comprise over half of the panel householdsreporting no telephone service in either the 1992 or 1993 surveys.These households are compared with the total nonphone populationand found to be similar on a variety of key demographic characteristics.Several statewide Virginia telephone surveys are used to comparehouseholds reporting "intermittent" phone service with nontelephonehouseholds surveyed through in-person interviews. Householdsreporting intermittent telephone service were very similar tonontelephone households in terms of health insurance coverageand other variables known to be related to telephone status.     

Measuring the quality of health care

This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making and practice styles are being monitored by purchasers as new health care delivery systems are being formed. The American Medical Association found that 39 percent of surveyed physicians were subject to clinical profiling.     

Bespoke program design for school-aged therapy disability service delivery

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.     

Decentralisation and devolution to the English regions: Assessing the implications for rural policy and delivery

The White Paper Your Region, Your Choice: Revitalising the English Regions opened the way for reforms to regional government in England which, it asserted, will improve decision-making and deliver better quality services. In the field of rural policy, too, there are demands for decentralisation to improve service delivery and reflect the diversity of rural areas. Drawing upon a case study of rural policy making and implementation in the English West Midlands, this paper explores current institutional structures for rural policy making and how further administrative decentralisation or political devolution might enhance them. It reveals a complex set of fragmented structures and blurred accountabilities in which policy implementation is an outstanding concern. The Government's administrative reforms, together with proposals to decentralise responsibility for rural service delivery, may assist in promoting greater differentiation and co-ordination at the regional tier. Nonetheless, in the absence of the transfer of significant resources and influence to an elected regional body, efforts to establish a more distinct and coherent approach to rural policy-making and delivery will continue to be hampered.