Abstract

Structuring managerial discretion has been a key government policy tool in contemporary regulation and governance. This article explores how a policy that constrains managers’ discretion in recruitment influences the performance of public services. The National Background Check Program (NBCP) is a federal program aimed at strengthening states’ criminal background checks targeting direct patient access employees in nursing homes, where abuse, neglect and misappropriations have been a persistent concern. We combine secondary administrative panel data on Medicare and Medicaid certified nursing facilities with primary data collected from states on their NBCP efforts. We find that NBCP participation, funding and the implementation of fingerprinting requirement, in particular, are associated with fewer deficiencies and higher star ratings. These findings suggest that, while constraining managerial discretion, government regulation is an important tool that federal and state agencies can use to control the performance of public and private entities in some markets and provide market enhancing signals to consumers.

摘要

构建管理自由裁量权一直是当代监管和治理中的关键政府政策工具。本文探讨了限制管理者在招聘中的自由裁量权的政策如何影响公共服务的绩效。国家背景调查计划 (NBCP) 是一项联邦计划，旨在加强各州的犯罪背景调查，目标是疗养院中直接接触患者的员工，其中虐待、忽视和盗用一直是一个令人担忧的问题。我们将有关 Medicare 和 Medicaid 认证护理设施的二级管理小组数据与从各州收集的有关其 NBCP 工作的主要数据相结合。我们发现，特别是 NBCP 的参与、资金和指纹要求的实施与更少的缺陷和更高的星级相关。