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

  • Richard Scheffler
  • Richard Smith


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. Copyright Springer Science+Business Media, LLC 2006

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Article provided by Springer in its journal International Journal of Health Care Finance and Economics.

Volume (Year): 6 (2006)
Issue (Month): 3 (September)
Pages: 237-258

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Handle: RePEc:kap:ijhcfe:v:6:y:2006:i:3:p:237-258
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  1. Philip J. Grossman, 1990. "The impact of federal and state grants on local government spending: A test of the fiscal illusion hypothesis," Monash Economics Working Papers archive-11, Monash University, Department of Economics.
  2. Mark Duggan, 2000. "Hospital Ownership and Public Medical Spending," NBER Working Papers 7789, National Bureau of Economic Research, Inc.
  3. Winer, Stanley L, 1983. "Some Evidence on the Effect of the Separation of Spending and Taxing Decisions," Journal of Political Economy, University of Chicago Press, vol. 91(1), pages 126-40, February.
  4. Fisher, Ronald C., 1982. "Income and grant effects on local expenditure: The flypaper effect and other difficulties," Journal of Urban Economics, Elsevier, vol. 12(3), pages 324-345, November.
  5. repec:mpr:mprres:3216 is not listed on IDEAS
  6. Rubinfeld, Daniel L., 1987. "The economics of the local public sector," Handbook of Public Economics, in: A. J. Auerbach & M. Feldstein (ed.), Handbook of Public Economics, edition 1, volume 2, chapter 11, pages 571-645 Elsevier.
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