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Performance‐Based Contracting in Wisconsin Public Health: Transforming State‐Local Relations
Author(s) -
Chapin John,
Fetter Bruce
Publication year - 2002
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00004
Subject(s) - negotiation , business , accountability , audit , state (computer science) , quality (philosophy) , public health , population , public administration , public relations , accounting , political science , medicine , nursing , environmental health , philosophy , epistemology , algorithm , computer science , law
W isconsin has long served as a laboratory for American federalism. In the 1990s, its public health system depended on a delicate equilibrium among federal, state, and local agencies, with little prospect for additional public funding. This article describes how the Wisconsin Division of Public Health devised a new system of funding based on a quasi‐market model, which cut the link between reimbursement and costs and at the same time gave local governments greater flexibility in providing public health services. Although they are not even mentioned in the U.S. Constitution and they are subordinate to the state in Wisconsin, local governments provide the bulk of the state's public health services (Donoghue 1979). This paradoxical imbalance between legislative power and administrative responsibility was not at issue during the nineteenth century, when public health services were rudimentary. In 1839, municipalities obtained the power to establish boards of health, and by 1883, all municipalities were required to have their own boards of health, the costs of which were left to the local taxpayers.