This study offers lessons for overcoming future economic crises by examining whether democratic management helped local governments recover their financial condition. During the Great Recession, local governments were forced to make painful decisions regarding increased taxes and user charges, and cuts in public services. Several case studies provide evidence that citizen participation allows localities to increase property taxes as well as cut public services. However, broader, systematic empirical research is lacking. This study found that local governments with participatory budgeting were more likely to improve their financial condition during the Great Recession. The results allow us to identify the role of citizens in fiscal decision-making, offering lessons on how local governments can overcome possible fiscal crises in the future.

Previous studies have reported a positive relationship between local government spending and health outcomes. However, there is limited scholarly research on how the different policy tools used for delivering public health services affect the health of local residents. This study adopted a comprehensive model, widely utilized in health policy and management research, to control for health behaviors, socioeconomic factors, physical environment, and clinical care. It provides evidence that a county with higher health spending through contracting has a higher health ranking among New York counties, indicating that service provision arrangements affect health outcomes. Thus, county efforts to improve health outcomes should consider the effects of differing service delivery arrangements.