One of the central questions in public management is how collaboration affects public service delivery? There is a rich body of theory and anecdotes that suggest collaboration among governments, non-profits, and private sector... [ view full abstract ]
One of the central questions in public management is how collaboration affects public service delivery? There is a rich body of theory and anecdotes that suggest collaboration among governments, non-profits, and private sector contractors lowers transaction costs and bolsters the professional capacity of public organizations. Unfortunately, there is little solid empirical evidence behind these assertions. We know even less about the specific effects of collaboration among local units of government, also known as cross-jurisdictional sharing (CJS).
In this paper we examine how cross-jurisdictional sharing among local public health districts affects the costs of public health services. Public health is an ideal setting to examine CJS. Public health districts in the US are generally organized by county. There are many of these districts and they provide similar services across geographically similar areas. As such, there are many opportunities to share services and leverage economies of scale, and many public health jurisdictions are engaged in a variety of cross-jurisdictional sharing arrangements to that effect. Moreover, many public health services have discrete, measurable outputs. For communicable disease services, as an example, public health agencies track the number of children immunized, the number of educational outreach sessions conducted, the number of tuberculosis cases identified and treated, and so forth. Each of these outcomes has a specific group of related costs. Public health districts track these units and costs at some detail.
To understand the scope and intensity of cross-jurisdictional sharing, in summer 2015 we administered a survey of 210 local health jurisdictions across four US states. This survey asked public health officials to report the number and types of CJS arrangements their jurisdiction had established, and the services to which those arrangements were connected. We received a 65% response rate, for a total of 136 local governments. The respondents include several large and high-profile public health jurisdictions, including New York City, Seattle, Portland (OR), Milwaukee (WI), and many others. We found that more than 75% of these governments are engaged in cross-jurisdictional sharing.
For the analysis in this paper we will combine these survey data with administrative data on the volume and costs of local public health services in areas like communicable disease control and maternal-child health services across these four US states. Our central empirical question is simple: Does cross-jurisdictional sharing produce lower unit costs for essential public health services? Our initial hypothesis, based on the existing literature, is that it does.
IRSPM_Presentation_-_Marlowe.ppt 