Contracting Out and Its Outcomes in Public Health: A Case of New York Counties

Previous studies have reported a positive relationship between local government spending and health outcomes. However, there is limited scholarly research on how the different policy tools used for delivering public health services affect the health of local residents. This study adopted a comprehensive model, widely utilized in health policy and management research, to control for health behaviors, socioeconomic factors, physical environment, and clinical care. It provides evidence that a county with higher health spending through contracting has a higher health ranking among New York counties, indicating that service provision arrangements affect health outcomes. Thus, county efforts to improve health outcomes should consider the effects of differing service delivery arrangements.