The determinants of public versus private provision of Emergency Medical Services
Competition for the provision of local public services often involves mixing private firms and public agencies. Predicting competitive outcomes therefore requires identifying the productive and strategic advantages of different organizational configurations: pure public, pure private or a public-private mix. We consider a make-versus-buy decision in a government procurement context by identifying the strength of public agencies as having an inherent advantage in accessing local infrastructure while private firms are identified as having a superior incentive to exploit returns to scale technologies due to their ability to service multiple localities. We focus on the choice of system configuration for the provision of Emergency Medical Services (EMS), a socially important service which benefits from infrastructural synergies as well as technological improvements (i.e. medical quality). We test our predictions on a panel data set of the 200 largest US cities and find that smaller cities and poorer access to hospitals favor the mixed public-private configuration in the provision of EMS.
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- Oliver Hart & Andrei Shleifer & Robert W. Vishny, 1997.
"The Proper Scope of Government: Theory and an Application to Prisons,"
The Quarterly Journal of Economics,
Oxford University Press, vol. 112(4), pages 1127-1161.
- Oliver Hart & Andrei Shleifer & Robert Vishny, 1996. "The Proper Scope of Government: Theory and an Application to Prisons," Harvard Institute of Economic Research Working Papers 1778, Harvard - Institute of Economic Research.
- Oliver Hart & Andrei Shleifer & Robert W. Vishny, 1996. "The Proper Scope of Government: Theory and an Application to Prisons," NBER Working Papers 5744, National Bureau of Economic Research, Inc.
- Jonathan Levin & Steven Tadelis, 2007. "Contracting for Government Services: Theory and Evidence from U.S. Cities," NBER Working Papers 13350, National Bureau of Economic Research, Inc.
- Trevor L. Brown & Matthew Potoski, 2003. "Managing contract performance: A transaction costs approach," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 22(2), pages 275-297.
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