Title XX Purchase of Service. Volume II: The Feasibility of Comparing Costs Between Directly Delivered and Purchased Services

摘要

Two objectives were defined for the feasibility portion of the Title XX purchase of service (POS) study. The first was to determine the feasibility of comparing costs for purchased services with the costs for services that are directly delivered by State Title XX agencies. The second was to determine the usefulness of these cost comparison data for State decisionmakers. Two conditions must be met to attain these objectives. First, the two methods of provision (direct and POS) must be comparable and second, the data required for a cost study must be available. Also, to be useful, the cost comparison data must pertain to areas in which States have real choices. Thus, the issues of comparability between the direct and purchased methods, data availability, and usefulness of cost comparison data must be examined. The States selected for the study, Hawaii, Minnesota, Missouri, Ohio, Texas, and Virginia, offered the greatest number of services by both direct and POS. Researchers spent 1 week in each State, conducting interviews and gathering any relevant written material. Findings indicate counseling, homemaker / chore, and substitute care are the only large services delivered by both direct and POS in half or more the States studied. Homemaker / chore services are delivered by varying methods, including direct delivery, in more States than any other service. It is recommended that homemaker / chore be used as the basis for a cost comparison study rather than adoption, home management, information and referral, and transportation services, also investigated here. The results of the entire feasibility study indicate that State managers are now using cost comparison data because accurate data are not currently available and because their real choices about methods of delivery are limited. The findings suggest that State managers would use cost comparison data if two criteria were met: the data must pertain to an important area of real choice, and the data must be high quality, so that State managers can have confidence in the choices indicated by the data. Tables are provided.