Shifting principles in a sacred market: Nonprofit service provision to foster children and families in a performance -based, managed care contracting environment.
McBeath, Bowen
2006
Abstract
Despite the incorporation of managed care and performance-based contracting models by public and nonprofit agencies in many state child welfare sectors, little empirical evidence exists concerning whether and how service provision to foster children and families responds to these different market environments. This thesis sought to answer the following research questions concerned with foster care service provision: (1) Is service provision different in performance-based, managed care versus fee-for-service contracting environments? (2) Does variation in service provision exist among nonprofit agencies? (3) Does variation in service provision exist within a single nonprofit agency? and (4) Should differences exist, what factors explain differential service patterns? These questions were examined using data from an evaluation of a performance-based, managed care initiative in the Wayne County, Michigan foster care system. In particular, the thesis examined variation in service provision to a sample of foster children and families that were served by nine nonprofit agencies in Wayne County. Six agencies (pilot agencies) contracted with Michigan's public welfare agency to provide foster care services under a performance-based, managed care reimbursement system that contained bonuses for the movement of foster children into permanent placements and the sustainment of these placements. The other three nonprofit agencies (non-pilot agencies) contracted to provide foster care under a fee-for-service reimbursement system. Because foster children are assigned to nonprofit agencies in Wayne County using an alphabetical queue of service providers as opposed to client-related factors, this thesis drew its sample from a research design that controlled for the characteristics of children and families. Using various multivariate econometric models, this thesis suggests that the intensity of nonprofit foster care service provision is diminished in the performance-based, managed care contracting environment. This thesis also finds dramatic differences in agencies' service intensity, even among agencies within similar contracting regimes, and even after controlling for time in care, various types of allegations of maltreatment, and child, primary caregiver, and caseworker characteristics. Yet the variation in service provision to foster children and families is due only in part to whom these children and families or their caseworkers are. The intensity of foster care service provision is somewhat influenced by whom children and families are, why they have come into foster care, and whom their caseworkers are; but it is much more heavily influenced by which agency is serving children and families and the institutional environment the agency has chosen. The implications of these findings and conclusions for research and practice are discussed.Subjects
Contracting Environment Families Foster Children Managed Care Market Nonprofit Organizations Performance-based Principles Sacred Service Provision Shifting
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