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An action research approach to reforming rural health and human services through Medicaid managed care: Implications for the policy sciences.

机译：通过医疗补助管理的医疗改革农村卫生和公共服务的行动研究方法：对政策科学的启示。

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Centralized decision making among upper levels of government and special interest groups, focused on targeted social problems, dominates the development of social public policy. This process produces narrowly framed solutions for implementation across broadly diverse settings. The site for the actualization of social policy, the local context, includes local government, service providers, consumers of those services, and the local citizenry. Yet the voice of the local geographic context is underrepresented among those voices shaping social public policy. The centralized policy process places the local government as the implementer of policy determined at higher levels of government, rather than as a partner in the public policy process itself. Thus policymaking processes systematically exclude key stakeholders. The absence of mechanisms for understanding and integrating the local experience into shaping social public policy not only inhibits the amelioration of social problems; in many instances it may worsen conditions and undermine the capacity of the local leadership to respond effectively, as this dissertation demonstrates.; In action research, community inquirers in partnership with a professional researcher systematically construct knowledge regarding locally defined problems in order to generate a contextualized plan for action. When conducted in partnership with local government, action research offers a mechanism for democratizing policymaking through increasing the voice of stakeholders previously excluded from decision making,; This dissertation represents an action research project conducted to develop and advocate for a local solution to problems associated with the design of the human service administrative system. As a representation of the action research project, this dissertation has two objectives. First, through a detailed description of the human service infrastructure in this context, it articulates the local perspective and experience of public policy developed through centralized processes, making the case for democratized policymaking. Second, it provides an analysis of a grassroots effort that sought to influence state public policy by creating and advocating for a contextualized response to a particular policy. Through this, the dissertation demonstrates how the process of local stakeholder participation in policymaking changed both the policy product, namely the program model, as well as the conditions for policy implementation.
机译：上级政府和特殊利益集团之间的集中决策集中在针对性的社会问题上，主导着社会公共政策的发展。这个过程产生了框架狭窄的解决方案，可以在各种各样的环境中实施。社会政策的实现站点（根据当地情况）包括地方政府，服务提供者，这些服务的消费者以及当地公民。然而，在塑造社会公共政策的那些声音中，当地地理环境的声音并未得到充分体现。集中的政策流程使地方政府成为上级政府确定的政策的实施者，而不是公共政策流程本身的合作伙伴。因此，决策过程系统地排除了主要利益相关者。缺乏了解和融合当地经验以形成社会公共政策的机制，不仅抑制了社会问题的改善；如本文所论证的那样，在许多情况下，这可能会使情况恶化并削弱地方领导人有效应对的能力。在行动研究中，社区询问者与专业研究者合作，系统地构建有关本地定义的问题的知识，以生成情境化的行动计划。与地方政府合作进行时，行动研究提供了一种机制，可通过增加先前被排除在决策之外的利益相关者的声音来使决策民主化。本论文代表了一项行动研究项目，旨在开发和倡导针对与人类服务管理系统设计相关的问题的本地解决方案。作为行动研究项目的代表，本论文有两个目标。首先，通过在这种情况下对人类服务基础设施的详细描述，阐明了通过集中化流程制定的公共政策的本地视角和经验，为民主化决策提供了依据。其次，它提供了对基层工作的分析，这些工作试图通过创建和提倡对特定政策的上下文响应来影响国家公共政策。由此，本文证明了当地利益相关者参与决策的过程如何改变了政策产品（即计划模型）以及政策实施的条件。

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