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Aligning Ideologies and Institutions: Reorganization in the HIV/AIDS Services Administration of New York City


Kimberley R. Isett is an assistant professor of management in the Mailman School of Public Health at Columbia University. She received her doctorate in management with a specialization in organization theory from the University of Arizona in 2001. Her research focuses on institutional pressures and dynamics in implementing government services, with a particular interest in coordination and collaboration among agencies.

Michael Sparer is a political scientist who is a leading national authority on intergovernmental relations in health policy and on Medicaid in particular. He is an expert on innovations in the delivery of health services to the disadvantaged, including the evolution of Medicaid managed care in New York City and the rise of managed care organizations launched by safety net providers in New York and other venues.

Sherry A. M. Glied is a health economist who has written widely on health policy, including the needs of and programs for such vulnerable groups as the uninsured and those in need of mental health services. She is an expert in the collection and analysis of data on the health system and on specifi c public programs within it, and served as a senior economist assisting in the development of health reform for the George H. W. Bush and Bill Clinton administrations. She is currently serving the Obama administration as Assistant Secretary of Health and Human Services for Program Planning and Evaluation.

Lawrence D. Brown is a political scientist who has written on the political prospects for health care reform at the national, state, and local levels of government. He has done extensive field research in the course of evaluating many programs seeking to expand coverage to low-income and uninsured populations. These include the Robert Wood Johnson Foundation's Community Programs for Affordable Health Care, the Foundation's Health Program for the Medically Uninsured, and the Foundation's Community in Charge Program.


How effective was organizational reform implemented inside one critical New York City health agency? Specifically, we examine the extent to which the reorganization of the HIV/AIDS Services Administration (HASA) into the Medical Insurance Services Administration (MICSA) achieved three goals: (1) realizing synergies among the component MICSA programs; (2) cross-fertilizing ideas among MICSA agencies; and (3) facilitating HASA operations through the lens of organization change theory. Qualitative methods including interviews, site visits, and document analysis triangulate the effects of the reorganization. Implications for organization change literature are explored, especially highlighting where more theoretical and empirical studies are needed.