Aging and Behavioral Health: Power and Accountability in Outsourced Public Policy Implementation

by Fry, Melissa Sue.

Devolution of the welfare state brings with it problems of democratic accountability to taxpayers, equality and uniformity in services, and the protection of vulnerable service populations. This research contributes to discussions of devolution and outsourcing by exploring the role of service populations in shaping the relationship between policy formation and implementation and the implications of this relationship for accountability in public policy implementation. A comparative analysis of community based services in aging and behavioral health illuminates the role of political power, professional interests, and organized advocacy in policy formation and implementation. The study pools evidence from legislative histories, newspaper archives, field observations, and surveys to provide a detailed account of the relationship between legislation and implementation. The findings suggest that the political power of service populations affects public policy formation, and written policies structure implementation organizations. Strengths and weaknesses of legislation are transferred to the organizations of implementation as state policies determine the constraints and resources that structure implementation organizations. 10