The impact of government decentralization on county health spending for the uninsured in California

Abstract

We analyze Program Realignment, California's 1991 policy of decentralizing control of health, mental health, and social services, from the state to the counties. Drawing from the economics literature on intergovernmental transfers and using data constructed for this study, we analyze the impact of Realignment on uninsured health spending. We find a change in the pattern of spending on indigent health services by counties following decentralization. Our results suggest, however, that county-level governments maintain a level of commitment to social-service spending that recent studies indicate may be lacking at the state level.

The impact of decentralization of health care administration on equity in health and health care in Canada

“…In a very similar setting,Scheffler and Smith (2006) find that after decentralization, the county-level governments in California maintain a level of commitment to social-services for indigent population that may be lacking at the state level. Prior to 1991, social services to the indigent population in California were directly financed by the State.…”

Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005

“…On a philosophical and ideological level, decentralization has been seen as an important political ideal, providing the means for community participation and local self-reliance, and ensuring the accountability of government officials to the population. On a pragmatic level, it has been seen as a way of overcoming institutional and administrative constraints and allowing a higher level of responsiveness to local needs, improved management of supplies and logistics, and greater motivation among local officers, thus facilitating and speeding up implementation (Larmour, Qalo et al 1985;Mills 1994) The great volume of literature that has accumulated over the past several years reflects the considerable attention being paid to this issue (Khaleghian 2004;Jimenez & Smith 2005;Scheffler & Smith 2006;Costa-Font & Moscone 2008). Nevertheless, we possess an uneven understanding of the degree to which decentralization is achieving its objectives.…”

The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis

“… See Sutton and Lock (2000),Gasparini and Ramos (2004),Costa-Font and Rico (2006),Scheffler and Smith (2006),Magnussen et al (2007),Montero-Granados et al (2007),Wagstaff and Lindelow (2007),Jiménez- Rubio et al (2008),Chou and Wang (2009), Costa-Font (2010), and Fang et al (2010. 2 For example, the Canadian federal government disburses the Canada Health Transfer (CHT) and Equalization payments to its provinces.…”

“…3 In this paper, "Public Assistance" refers to a specific social assistance scheme in Japan.4 The term "transfer deficit" was kindly suggested by Professor Pedro P. Barros. 5 SeeHäkkinen and Luoma (1995),Gordon et al (1997), DiMatteo and Di Matteo (1998), Cantarero (2005),Crivelli et al (2006),Scheffler and Smith (2006), Costa-Font and Pons-Novell(2007), Moscone et al (2007), Andersson and Henriksen (2008), Rahman (2008), Mays and Smith (2009), and Costa-Font (2010).…”