Vast, but disparate, literatures study hospice care, but none explains how government policy affects the dying experience of terminally ill patients and their families. This topic is of the utmost significance as there are important unanswered questions that fall under the purview of public administration, and may be in conflict with its principles of truth, efficiency, effectiveness and equity. This dissertation is formatted as three related essays in the area of hospice care. The first essay informs government policy in end-of-life care with insights from government policy in child care. The methodology consists of trend analysis in order to better understand the elder care choices of adult children who have elderly parents or relatives that need hospice care. The methodology is focused on married households and the data was extracted from the Current Population Survey (CPS). The study finds that married households in the middle income bracket are less likely to bring their elderly relatives into their homes as long as the Medicare hospice benefit remains a viable alternative to the demands that hospice care at home may impose on household income and in labor participation. Trend analysis of median household income and Child and Dependent Tax Credit demonstrate that the tax code can be an effective tool in promoting hospice care at home. The second essay studies how the Medicare Hospice Program affects the financial viability of the hospice organization, and in turn, affects the survival of terminally ill patients. The methodology consists of Panel-Corrected Standard Errors regression technique and focuses on the organizational effects rather than on the individual effects on length of stay. The study finds that the liquidity of the hospice organization and investment in human capital in the form of nurses influence how long a patient stays in hospice care. The assessment of the hospice organization's financial health is a novel development as well as beachhead for extending the theory of non-profit financial management into hospice care. The third and final essay analyzes whether government policy on aging has an effect on the distribution of firms, non-profit or for-profit, offering hospice care. The essay analyzes hospice care organizations from a population ecology perspective and tests a resource-partitioning model in order to explain the interorganizational relationships between generalist and specialist organizations. The methodology applied is fixed effects regression and the essay links the resources in the environment with the organization and patient outcomes. The study finds that the age of the generalist form of hospice organization providing core services increases the length of stay. This finding runs counter to the literature that promotes dying at home as the way to increase survival time during hospice care. The three essays share the goal of better understanding the effect that Medicare hospice policy has on the end of life. The end outcome of the essays show that government policy in the form of the Medicare hospice benefit may in fact undermine the hospice care philosophy or self-determination and dying in our own terms. This dissertation is the first to consider that government policy in the form of hospice care may have evolved into a health program that counters rather than supports the axioms of the hospice philosophy. / A Dissertation submitted to the Reubin O' D. Askew School of Public Administration and Policy in partial fulfillment of the Requirements for the degree of Doctor of Philosophy. / Spring Semester, 2013. / March 6, 2013. / Financial Management, Hospice, Lenght of stay, Nonprofit, Political Economy, Resource Partitioning / Includes bibliographical references. / Robert J. Eger, III, Professor Co-Directing Dissertation; Lance de Haven-Smith, Professor Co-Directing Dissertation; Susan C. Losh, University Representative; William G. Weissert, Committee Member; William Earle Klay, Committee Member.

This dissertation provides an analysis and evaluation of factors influencing states to enact inpatient health care transparency laws between 1971 and 2006 inclusive, using event history analysis. The primary research question investigates "What factors influence a state legislature to enact a health care transparency law?" To narrow the scope of study, I focus on factors influencing states to enact health care transparency laws to collect and publicly report inpatient data. The Unified Model of State Policy Innovation, developed by F.S. Berry and W.D. Berry (1990, 1999), provides the framework for the study hypotheses and the analysis of inpatient health care transparency law enactments by states. The Unified Model of State Policy Innovation posits a unified explanation for state policy adoptions. The model unifies the internal determinants and regional diffusion approaches of analysis for state policy adoption. This study tests eight hypotheses using event history analysis (EHA). EHA is an analytical technique that allows for the testing of a state government innovation theory that incorporates internal determinants and regional influences on state policy adoption. Although there are numerous methods to conduct event history analysis, this study uses the Cox proportional hazards model (also known as Cox regression). Cox regression is a popular method for studying time-to-event data for policy adoption and diffusion studies. This study's quantitative analysis provides support for legislative ideology and unified party control of state government acting as factors influencing inpatient health care transparency law enactments by states. Additionally, the health care crisis and neighbors variables were statistically significant, but in an opposite direction than predicted. The findings of this research suggest that state adopters of an inpatient health care transparency law are more likely to enact an inpatient health care transparency law when the state government is increasing in liberalism and when unified political party control of the governor and the governorship of both houses of the state legislature is increasing. To generate new insights into the enactment of inpatient health care transparency laws, I conduct a case study of a national health care data professional association using several techniques, including telephone interviews. The qualitative analysis provides support for professional associations and policy champions as diffusion agents for inpatient health care transparency law enactments by states. This dissertation supports variables traditionally used in policy adoption research including legislative ideology and unified political party control in state government. However, it will be interesting to see whether internal determinants such as professional associations gain traction over the traditional regional diffusion influences such as states sharing borders as factors influencing state policy adoption. Meanwhile, as evidenced in this study, there continues to be support for a model incorporating both internal and regional influences to explain policy adoption by states. The theory of policy innovation and diffusion to predict the factors influencing the spread of policies and the use of Berry & Berry's (1990, 1999) Unified Model of State Policy Innovation prosper as their applicability to numerous public policy areas, including health care, are continually demonstrated. Similarly, event history analysis and specifically the Cox regression method continue to gain support as their value as analytical methods and appropriateness for use in public policy studies is repeatedly demonstrated. The outlook for the future of the health care transparency movement looks promising. The health care transparency movement promotes improved access to information, patient empowerment, improved patient safety and quality of care, improved provider accountability, and lower health care costs. This movement is not a fad, but rather a permanent change being implemented in all health care settings across the United States. Improved health through reliable, accessible data and data-supported decisions is increasingly becoming the norm and less an idealistic scenario to be realized in the distant future. / A Dissertation submitted to the Reubin O’ D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2013. / March 21, 2013. / cox regression, event history analysis, policy adoption, policy diffusion, public reporting, transparency / Includes bibliographical references. / Frances Stokes Berry, Professor Directing Dissertation; Carol Weissert, University Representative; Lance deHaven-Smith, Committee Member; Keon-Hyung Lee, Committee Member.

The purpose of internal audit, according to the Institute of Internal Auditors (IIA), is to evaluate and improve the effectiveness of an organization's risk management, control, and governance processes. Weaknesses in any of these areas pose a threat to the organization's legitimacy with its stakeholders. Many organizations worldwide are required to adopt internal audit. However, other institutions, like American municipalities, are not. A municipality's decision to adopt internal audit is the responsibility of local leadership. Current economic pressures require that leaders consider a cost/benefit analysis before making a decision. Defining the costs of internal audit is relatively easy, but measuring its benefits is more elusive. This research examines whether the results of external audits may be used as an objective measure of internal audit benefits. The literature on internal audit quality does not identify externally derived measures that are independent of the function. This dissertation fills this gap. A logit model is used with data from 162 Florida cities to determine whether the presence of an internal audit reduces the likelihood of a city receiving findings in the independent external annual audit of their financial reports. The results are evaluated using legitimacy theory. Examining internal audit through this framework explains the difficulty in measuring the effectiveness of internal audit. The results indicate that objectively defining the benefits of internal audit may not be possible. They indicate instead that internal audit benefits, while real, may largely be abstract or symbolic. The internal audit role is best viewed as deterrent in nature. This poses challenges to those attempting to identify objectively measurable benefits. The implication is that municipal leadership should seek to understand the conceptual nature of the internal audit function before making resource allocation decisions. The loss of benefits from cuts to or elimination of the internal audit function may not be evident until sometime after making those funding decisions. The results of this research demonstrate the importance of internal audit, as well as the need for more investigation to further understand the nature of its effects. / A Dissertation submitted to the Reubin O' D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2013. / June 18, 2013. / Audit, Governance, Internal Audit, Legitimacy, Local Government, Municipal / Includes bibliographical references. / James Bowman, Professor Directing Dissertation; Gerald Ferris, University Representative; Lance deHaven-Smith, Committee Member; Kaifeng Yang, Committee Member; Brad Gomez, Committee Member.

This dissertation investigates the formation and change of city boundaries in the United States since World War II (WWII). By drawing on previous literatures, it extend a political economy perspective that emphasizes trade-offs in the configuration of municipal boundaries. The dissertation investigates the role of ethnic heterogeneity in the formation of municipal jurisdictions since WWII. This research thus aims to advance, theoretically and empirically, our understanding of local government organization in recent history. The dissertation also builds on institutional foundations of local government organization. In a separate section, the dissertation analyzes the role of homeowner associations as alternative institutions of governance. The dissertation generally frames boundary change as bottom-up initiatives constrained by institutions of American federalism. This dissertation offers an empirical study of boundary change through a historical template: 1940 through 2000. It thus puts together local government datasets on population, socioeconomic, and institutional factors influencing boundary formation events over the postwar. The datasets have been particularly constructed to facilitate future replication and dissemination efforts. / A Dissertation submitted to the Reubin O' D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2013. / June 18, 2013. / Includes bibliographical references. / Richard Feiock, Professor Directing Dissertation; Robert Jackson, University Representative; William Earle Klay, Committee Member; Lance deHaven-Smith, Committee Member; Kaifeng Yang, Committee Member.

Over the past several decades, governments have carried out many public administration reforms in order to enhance public sector performance. However, the focus of the research on administrative reforms has been on their adoption and implementation, while their impacts have rarely been carefully tested. At the local level, various reforms are designed, reflecting multiple and sometimes competing values. This study empirically examines the impacts of three major local administrative reforms--e-government, citizen participation and contracting--on three dimensions of local government performance (efficiency, effectiveness, and equity). For the empirical tests, this study carefully reviews the prior studies and measures the three local administrative reforms and their dimensions with data from several national surveys. This study also objectively measures multiple performance variables based on open archival sources, improving on prior studies that largely focused on internal outputs or a single performance dimension. This study finds that (1) three reform areas are usually not associated with efficiency; (2) e-management and administrative participation channels are positively associated with effectiveness; and (3) e-democracy and administrative participation channels are positively associated with equity. / A Dissertation submitted to the Reubin O’D Askew school of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2013. / June 19, 2013. / effectiveness, efficiency, equity, performance, reforms, values / Includes bibliographical references. / Kaifeng Yang, Professor Directing Dissertation; Gerald. R. Ferris, Committee Member; William Earle Klay, Committee Member; Richard C. Feiock, Committee Member.

Public sector leadership calls on public administrators to possess skills to resolve complex policy problems/crises and balance political interests and values through negotiation and conflict resolution. However, current leadership theories in the public administration literature have not paid sufficient attention to this issue. Even more surprisingly, almost no empirical studies have been done to measure and explain this particular dimension of public sector leadership. While the business literature has studied individual political skills focusing on interpersonal situations, the political skill construct in the field of public administration should consider both internal and external political environments. Thus, this study develops a new multidimensional construct--public political skill (PPS) that contains three sub-dimensions: political astuteness, inclusive skill, and visionary skill. Using survey data from the Florida Center for Public Management, this new construct is defined using confirmatory factor analysis and is tested for internal reliability and construct validity. Results show that PPS is different from the political skill inventory (PSI) developed by business scholars. In addition, the results find that PPS not only contributes to job promotion and satisfaction but also attenuates the negative effects of red tape on job satisfaction and neutralizes job tension. Yet, the PPS on job tension model shows insignificant results and the interaction with goal ambiguity has dazzling findings which require further discussion. The implications from these results and direction for future research are provided. / A Dissertation submitted to the Reubin O'D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2012. / June 12, 2012. / Political skill inventory, Public political skill, Public sector leadership / Includes bibliographical references. / Kaifeng Yang, Professor Directing Dissertation; Gerald R. Ferris, University Representative; Frances S. Berry, Committee Member; Ralph S. Brower, Committee Member.

A Dissertation submitted to the Reubin O'D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2005. / November 2, 2005. / Economic Development Policy, Joint Venture, Regional Partnership, Interlocal Cooperation and Network, Instituional Collective Action, Social Capital, Transaction Cost, Metropolitan and Local Governance / Includes bibliographical references. / Richard C. Feiock, Professor Directing Dissertation; John T. Scholz, Outside Committee Member; Frances S. Berry, Committee Member; Lance deHaven-Smith, Committee Member.

This dissertation is about policy decision making in transportation infrastructure. With this dissertation an attempt is made to understand factors which affect policy decisions in state governments or within the public sector. The dissertation analyzes the factors influencing policy decisions related to High Speed Rail (HSR) in the 48 contiguous states. To analyze the administrative decision making more systematically, this dissertation constructs a new decision making framework. The Eastern Three Elements (ETE) framework combines three established models in decision making. Using the ETE framework, the dissertation analyzes the reasons for the repealed Florida High Speed Rail (FHSR) and the reasons for the continuing progress of the California High Speed Rail (CHSR). By comparing the underpinning decision making, the dissertation provides factors that influence the policy decisions within state government. By recognizing these factors, the dissertation constructs hypotheses from the theoretical development, and empirically tests this underlying theory through a generalization to all states affected by the U.S. High Speed Rail Project. The finding is that the ETE framework provides a more complete analysis of the decision making in public transportation. These analyses provide evidence to assist in our understanding vis-à-vis the implications of today's public transportation system construction and public infrastructure policies. / A Dissertation submitted to the Reubin O'D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2012. / July 25, 2012. / California High Speed Rail, ETE Framework, Florida High Speed Rail, High Speed Rail, Policy Decision Making, Transportation Infrastructure / Includes bibliographical references. / Robert J. Eger, III, Professor Directing Dissertation; Randall G. Holcombe, University Representative; Frances S. Berry, Committee Member; KeonHyung Lee, Committee Member.

This research contemplates the influence of donors' security concerns on humanitarian aid and development. The phenomenon has been referred in the literature with various titles including securitization of aid, politics of aid, security-aid nexus and securitizing human development. While the extant literature delves into the impact and influence of securitization of aid on humanitarian development and its undermining effects on voluntary sector; this study explores the phenomenon from the perspective of the aid recipients with the assumption that the recipients' outlook and beliefs regarding the donors' intentions and motives influence the effectiveness of the humanitarian aid. The study contributes towards the development literature by identifying the factors shaping the perception of the aid recipients about donors and NGOs. The factors, thus explored, are going to facilitate the work of the humanitarian aid agencies in a politically hostile or conflict riddled societies and may also prove beneficial for policy makers. The data depicts that the culture and institutions of the region plays an important role in shaping the recipients' perceptions of donors and NGOs and that if due consideration is given to these elements it may help rebuilding societal trust on humanitarian efforts. This study employs Bourdieu's theorization of capital and its role in determining power within the society. The premise is that actors can use the capital possessed by them for acquiring other types of capital possessed by other actors in the field and thus can improve their position within the field. Thus, the economic capital of the donors can be utilized to earn social capital and cultural capital possessed by local NGOs. / A Dissertation submitted to the Reubin O'D Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2015. / March 3, 2015. / Cultural Capital, Development, Securitization of aid, Social Capital, Symbolic Capital, Tribal Areas and Swat / Includes bibliographical references. / Ralph S. Brower, Professor Directing Dissertation; Stephen McDowell, University Representative; Frances Berry, Committee Member; Lance deHaven-Smith, Committee Member.

The research question guiding of this dissertation asks, "How and to what extent do network relations of a city with organizations within its community and external networks with external governmental and other development actors influence success in attracting jobs, business, and economic development?" Little to no empirical research has touched on the effects of a certain type of network on performance. Thus, this dissertation investigates whether the scope and type of networks (internal and external networks) are related to the performance of economic development (e.g., change in the manufacturing employment, firms, investment). A transaction costs based theoretical framework is advances in which government's internal networks with organizations in the community and external networks with other governments and development actors influence the transaction costs of economic development. Network relationships are identified based on a national survey of cities conducted in 2004. Patterns of manufacturing development growth from 2002 to 2007 are estimated based on network structure, development policies, political structure, regional competition, and socioeconomic characteristics. Two sets of regression equations based on these models are estimated to test these hypotheses. The implications of the findings for research and practice will be discussed in the conclusion. / A Dissertation submitted to the Reubin O'D. Askew School of Public Administration and Policy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2012. / February 27, 2012. / Local Economic Development, Network, Performance, Social Capital, Transaction Cost / Includes bibliographical references. / Richard Feiock, Professor Directing Dissertation; Charles Barrilleaux, University Representative; Lance deHaven-Smith, Committee Member; Keon-Hyung Lee, Committee Member.