Reforming Medicaid through Contracting: The Nexus of Implementation and Organizational Culture
研究了堪萨斯州通过与非营利机构签订合同来改革医疗补助案例，发现合同制改变了机构角色、增加了政治冲突，但成本节约等目标未完全实现。
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 inter-agency 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.