Equity in the distribution of health and welfare services: Can we rely on the state to reverse the 'inverse care law?'

It has been suggested that the fiscal crises experienced in many industrial nations has been made worse by the drain on the state's economy of an ever-growing welfare state. Proposals to decentralize funding for health and welfare services, and to rely more on local, private, and 'grass roots' services, have been received enthusiastically. The question raised in this paper is whether the shift away from provision by the state will bring about a more or less equitable distribution of resources. The paper considers the spatial distribution of treatment services for two groups of the population who have become largely dependent on the state: namely, the mentally ill and alcoholics. The results suggest that as the federal government withdraws from the provision of services, neither the states nor the localities can be relied on to guarantee a minimum level of services to the truly needy. In the case of alcoholism services there is also some question about whether 'grass-roots' provision would be sufficiently responsive to the distribution of needs.