Qualitative analysis and case studies of public health privatization contracts: Implications for the achievement of public health policy goals.

摘要

Privatization of Public Health services is occurring among local and state health departments and is part of a larger movement to lower municipal government costs while maintaining or improving services. The content of the public health privatization contract is essential for proper risk management and achievement of successful project outcomes and desired public policy goals. A poorly written contract negates project planning, exposes the Local Health Department (LHD) to unnecessary financial and legal risks, and makes contract monitoring and evaluation difficult.; This study explored the literature regarding history and scope of privatization of governmental, particularly Public Health, services and threats and opportunities posed by privatization to the achievement of public policy goals. A typology of privatization techniques and specific applications to Public Health is presented. The most common form of privatization, contracting-out, is differentially analyzed using business and microeconomic theory and the inherent discretionary governmental powers and “guardian class” activities of Public Health. Concentration on “core competencies”, “Make-It or Buy-It” decision-making logic, and other established tenets of privatization policy are presented to aid in policy analysis of Public Health privatization contracts.; This study used qualitative and case study methodology to reveal and describe the contents of a sample of sixty-five privatization contracts. Initial research questions were formulated from a review of the legal, organizational, and firm theory literature, recognized model contracts and expert opinion. Each contact was analyzed using the initial set of research questions. As interesting patterns, clauses, standards and/or language were discovered, each contract was revisited and reanalyzed based on emerging research criteria. This process lead to development of a contract evaluation instrument (CEI) which was used to evaluate all contracts and is reported, tabulated and quantified. An in-depth case study analysis of important environmental contracts for disposal of household hazardous waste and residential lead-based paint inspection was also performed using state and federal guidance documents as benchmarks.; The clause and contract quality of the overall sample and individual contracts informs a discussion and conclusions regarding the ability of contracts to achieve the Public Health policy goals of privatization. Recommendations for contract improvement and further research are presented.