title: 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.
authors.affiliation: Health Economics and Public Policy, School of Public Health and Goldman School of Public Policy, University of California, Berkeley, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Scheffler
authors.forename: Richard B
authors.initials: RB
authors.lastname: Smith
mesh_terms: D002140:California; D003361:Cost Allocation; D003430:Cross-Sectional Studies; D005102:Health Expenditures / Q000639:trends*; D006296:Health Services / Q000191:economics; D006801:Humans; D009111:Local Government; D016015:Logistic Models; D008489:Medical Indigency; D017057:Medically Uninsured; D008605:Mental Health Services / Q000191:economics; D017059:Models, Econometric; D011057:Politics; D011640:Public Policy; D012947:Social Work / Q000191:economics; D013219:State Government; D017664:Uncompensated Care / Q000191:economics*