Journal of Public Budgeting Accounting & Financial Management

Dollery, Brian; Fletcher, Michael; Prasada Rao, D.S.

doi: 10.1108/JPBAFM-10-04-1996-B001pmid: N/A

Australian fiscal federalism possesses a greater degree of vertical imbalance than comparable federations elsewhere due to a concentration of revenue-raising powers at the level of the Commonwealth government and a concentration of expenditure functions at the state and local government levels. Efforts to deal with this problem have focused on intergovernmental grants. While substantial literature exists on the financial nexus between the Commonwealth and state governments, little research effort has been expended on the local government grants process. The present paper seeks to remedy this by documenting the evolution and role of the local government grants process.

Pearson, Timothy A.; Brooks, Richard C.; Neidermeyer, Adolph A.

doi: 10.1108/JPBAFM-10-04-1996-B002pmid: N/A

This research uses data from 2,470 not-for-profit-organizations (NFPOs) to examine the impact of organization size, risk, and complexity on monitoring costs in the NFP sector. OLS regression analysis indicate that monitoring costs are higher for (a) larger NFPOs, (b) NFPOs subject to the Single Audit Act, 8 NFPOs having larger amounts of assets tied up in receivables and inventories, (d) NFPOs spending a larger percentage of their expenses on program support services, and (e) NFPOs providing higher compensation to their officers and directors. In addition, some NFPOs such as schools and hospitals are associated with higher monitoring costs.

Garner, C. William

doi: 10.1108/JPBAFM-10-04-1996-B003pmid: N/A

Can school districts become too large whereby their size exceeds their point of efficiency? To investigate this question, all K-12 school districts in New Jersey were divided into three groups based on student body size. In a comparison of six average cost measures, larger districts were found to be more efficient on only one of the six measures. A more optimum size for school districts appeared to be in moderate sized districts. The theoretical grounds for this investigation regarded the suggested effects of vertical and horizontal decentralization.

Samuels, Michael E.; Shi, Leiyu; Campbell, Norma J.

doi: 10.1108/JPBAFM-10-04-1996-B004pmid: N/A

This article is a descriptive revenue profile of Community and Migrant Health Centers providing preventive and primary health care services to underserved rural and urban populations throughout the United States. The study is a secondary data analysis of the 1994 Bureau Common Reporting Requirements (BCRR) reports of the 626 Community and Migrant Health Centers to the Bureau of Primary Health Care. The purpose of the analysis is to examine the sources of revenue of the centers and consider the implications for public policy. In 1994, the 626 centers generated more than $2 billion from all payment sources to care for more than 7 million users. The findings should guide and assist policy makers at the state and federal levels in first deciding the role of C/MHCs in developing managed health care strategies for underserved rural and urban populations and developing the appropriate funding policies to support these decisions.

Ward, David M.

doi: 10.1108/JPBAFM-10-04-1996-B005pmid: N/A

This paper looks at resource allocation in New York state long-term care facilities. Data from 399 nursing facilities are used to compare resource allocation in 1983 and 1990. Given significant changes within the industry, it was hypothesized that significant changes would have occurred over the seven year period. Results indicate that growth in full time equivalents was 7.6 percent or an average of 13.5 employees. The allocation of resources across job title was, however, constant over the seven year period. Differential growth rates were found by ownership category, but there were only minimal differences with respect to the allocation of resources.

Lee, Robert H.; Chamberlain, Ronna

doi: 10.1108/JPBAFM-10-04-1996-B006pmid: N/A

This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.

Ehreth, Jenifer

doi: 10.1108/JPBAFM-10-04-1996-B007pmid: N/A

The State of Washington’s Mental Health Division (MHD) is the State agency responsible for providing state sponsored mental health services. In 1993, the MHD received a Health Care Financing Administration (HCFA) waiver to implement a statewide system of managed care for outpatient mental health rehabilitation services. Payments were to be prepaid and capitated and based on the numbers of clients in each of at least 3 payment tiers. This paper describes financial findings from a HCFA-mandated evaluation of the waiver. It looks at payment rates for children and adults, by tier, and for separately rated groups such as the categorically needy, medically needy, and disabled clients. Three types of State expenditures are compared in this paper: predicted expenditures based on actuarial projections, expenditures made on the basis of service utilization, and expenditures made after being adjusted for over payment controls. Expenditure predictions were consistently lower than actual expenditures, even after adjustments for over payment.

Salvo, James V.; Lutes, Michael; Jones, Walter J.

doi: 10.1108/JPBAFM-10-04-1996-B008pmid: N/A

Hospitals, physician groups, and other healthcare organizations (HCOs) are joining together in a multitude of new ways in ever increasing numbers. This process or strategy is often called “integrating” and results in some form of integrated delivery system (IDS) or accountable health plan (AHP) if an insurance function is part of the system. Recent literature suggests that many HCOs are not meeting their integration objectives, with resulting financial and structural difficulties. One of the major causes is the failure to follow a developed plan for integration planning and implementation. Organizations in other industries often rely on written guides to help them efficiently accomplish complex projects. HCOs that use a guide such as the one suggested here should improve the chances of a successful and financially viable integration.