Government agencies worldwide have faced budget cutbacks. Possible effects of budget cutbacks on the propensity to contract out have been discussed repeatedly; however, empirical evaluations are lacking. This study tests the contingency theory regarding the main factors that influence the propensity to contract out health and human services in response to fiscal stress: cutback levels, training and development, political factors, diversity as a goal, and the role of unions. The empirical analyses used a nationwide survey of health and human services directors in United States (U.S.) county governments, merged from different sources. The findings suggested that managers’ perceptions of cutback levels are a vital predictor of the propensity to contract out health and human services, and multiple factors have varied influences on their decision to do so in cutback situations. Implications for effective contracting strategies to maintain health and human service delivery, as well as preserving a balanced budget, are discussed.

中文翻译：

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影响因政府削减而外包卫生和公共服务的可能性的因素：来自美国各县的证据

全世界的政府机构都面临预算削减。重复讨论了预算削减对外包趋势的可能影响；但是，缺乏实证评估。这项研究测试了权变理论，涉及影响财政压力而倾向于外包卫生和公共服务的主要因素：削减水平，培训和发展，政治因素，多样性作为目标以及工会的作用。经验分析使用了美国（县）县政府对卫生和公共服务主管的全国调查，并从不同来源进行了合并。调查结果表明，管理者对削减开支水平的看法是健康和公共服务外包倾向的重要预测指标，在缩减的情况下，多种因素会影响他们的决策。讨论了维持健康和公共服务以及保持预算平衡的有效合同策略的含义。