When do we "just say no"? Policy termination decisions in local hospital services.(Report)

Introduction

Policy termination is an integral part of the policy process (Bardach, 1976; Geva-May, 2004), typically described as including agenda setting, policy formation, implementation, evaluation, and finally, termination. Yet, it has been a relatively understudied process (Geva-May, 2004). Daniels (2001) argues that policy and organizational termination remains a "wrongly underattended" research focus, a description first applied to this subject 30 years ago by Robert Biller (1976). This lack of research attention has left many basic questions unanswered. Is there an identifiable pattern of policy termination? What are the factors affecting the termination decision? Does the policy arena affect the termination process?

The paucity of knowledge on termination is especially problematic at a time when governments are concurrently facing increasing financial constraints and increasing public service expectations. It is thus critical that governments identify effective programs (to better serve their constituencies) and eliminate ineffective ones (to reduce public expenditures). Indeed, the governance and public management reforms of the past two decades carry the expectation that governments can and will regularly reevaluate their programs, and terminate those that are ineffective or no longer needed. For such efforts to result in better governance, it is necessary that we understand the termination process. For example, what kinds of programs are likely to be terminated? Are termination decisions likely to be based on ideology or on efficiency? Do governments terminate ineffective programs?

This study seeks to advance our understanding of the termination decision by developing and empirically exploring a model of the termination process faced by local government decision makers. In the next section, we build on the existing termination literature to develop a two-stage decision-making model. Then, we empirically explore the model using data on California public hospital provision over 15 years. We conclude with a discussion of the implications of the results for our understanding of the termination process in general and the determinants of local public hospital termination in particular.

Model Development

Developing a model of the policy termination process faces three important challenges--definition, decision-making arena, and important determinants. We consider the first two briefly, and the last in more detail as it has received the most attention in the literature. Peter deLeon (1978) broadly defined public policy termination as "the deliberate conclusion or cessation of specific government functions, programs, policies, or organizations." This definition, which does not include less drastic changes in policy emphasis or jurisdiction, retains its analytic usefulness, as it is usually possible to identify cessation. (1) Our interest here is in program termination--the explicit decision by government to stop publicly producing the service. Our model, however, will be constructed to explain policy termination broadly defined. As Bardach (1976) argued, it is usually unnecessary to differentiate policies, programs, and organizations in the context of policy termination, as efforts to terminate any generate similar political contests.

These political contests can occur at any level of government, and presumably, the institutions if not the nature of the process varies by decision-making arena. Most of the empirical work in policy termination has focused on the termination of federal policies, programs, and organizations (e.g., Frantz, 1997, 2002; Kaufman, 1976; Kirkpatrick, Lester, & Peterson, 1999; Lewis, 2002). Our interest is in local termination decisions, and these have not been widely studied. Yet, this arena has the capacity to be particularly revealing about the determinants of termination. Local decision makers are closest to both the pro- and anti-termination forces, and the consequences of ending policies or organizations will be especially clear. In summary, our model will focus on the local governance context within which the decision to terminate public policies are made.