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State health policy making determinants, theory, and methods: A synthesis


  • Edward Alan Miller


The American states exhibit considerable differences in health policy and market characteristics. Not only do they display substantial variation in spending, but they also display substantial variation in the strategies chosen to control costs, improve access, and ensure quality care. This article synthesizes studies that use 50-state statistical techniques to model policy adoption in the health sector. The purpose is to assess the strengths and weaknesses of this literature, to place it in the context of comparative state policy research generally, and to identify factors that best predict 17 health policy outcomes at the state level. A database was assembled containing 245 equations abstracted from 63 studies published between 1975 and 2002. Some predictors (such as income, aged population, public opinion, and nursing home beds) were studied much more frequently than others (e.g., education, divided government, federal Medicaid mandates, other states' adoptions). Results show that 43 of the 87 policy making determinants examined consistently predict two or more state-level outcomes, including four that predict five outcomes (non-white, urban, income, unemployment), two that predict six (tax capacity/effort, hospital beds), and two that predict seven (nursing home beds, liberal public opinion). Gaps are shown to exist in our understanding of the policy making effects of political system and intergovernmental characteristics.

Suggested Citation

  • Edward Alan Miller, 2005. "State health policy making determinants, theory, and methods: A synthesis," Social Science & Medicine, Elsevier, vol. 61(12), pages 2639-2657, December.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:12:p:2639-2657

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    References listed on IDEAS

    1. Cromwell, Jerry & Hurdle, Sylvia & Wedig, Gerard, 1986. "Impacts of Economic and Programmatic Changes on Medicaid Enrollments," The Review of Economics and Statistics, MIT Press, vol. 68(2), pages 232-240, May.
    2. Antel, John J & Ohsfeldt, Robert L & Becker, Edmund R, 1995. "State Regulation and Hospital Costs," The Review of Economics and Statistics, MIT Press, vol. 77(3), pages 416-422, August.
    3. Lanning, Joyce A & Morrisey, Michael A & Ohsfeldt, Robert L, 1991. "Endogenous Hospital Regulation and Its Effects on Hospital and Non-hospital Expenditures," Journal of Regulatory Economics, Springer, vol. 3(2), pages 137-154, June.
    4. Reutzel, Thomas J., 1989. "Medicaid eligibility, benefits, and provider payment: state preferences and implications for national goals," Health Policy, Elsevier, vol. 11(3), pages 209-226, June.
    5. repec:cup:apsrev:v:82:y:1988:i:04:p:1089-1107_19 is not listed on IDEAS
    6. Cone, Kenneth R & Dranove, David, 1986. "Why Did States Enact Hospital Rate-Setting Laws?," Journal of Law and Economics, University of Chicago Press, vol. 29(2), pages 287-302, October.
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    Cited by:

    1. Chen, Zhuo & Roy, Kakoli & Haddix, Anne C. & Thacker, Stephen B., 2010. "Factors associated with differences in mortality and self-reported health across states in the United States," Health Policy, Elsevier, vol. 94(3), pages 203-210, March.
    2. Judite Goncalves & France Weaver, 2014. "Home care, hospitalizations, and doctor visits," Research Papers by the Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva 14095, Institut d'Economie et Econométrie, Université de Genève.


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