IDEAS home Printed from https://ideas.repec.org/a/kap/ijhcfe/v6y2006i3p237-258.html
   My bibliography  Save this article

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

Author

Listed:
  • Richard Scheffler
  • Richard Smith

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. Copyright Springer Science+Business Media, LLC 2006

Suggested Citation

  • Richard Scheffler & Richard Smith, 2006. "The impact of government decentralization on county health spending for the uninsured in California," International Journal of Health Economics and Management, Springer, vol. 6(3), pages 237-258, September.
    • Handle: RePEc:kap:ijhcfe:v:6:y:2006:i:3:p:237-258
    DOI: 10.1007/s10754-006-9003-6
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1007/s10754-006-9003-6
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.1007/s10754-006-9003-6?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Katherine Baicker & Douglas Staiger, 2005. "Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(1), pages 345-386.
    2. Alice M. Rivlin, 1991. "Distinguished Lecture on Economics in Government: Strengthening the Economy by Rethinking the Role of Federal and State Governments," Journal of Economic Perspectives, American Economic Association, vol. 5(2), pages 3-14, Spring.
    3. Zampelli, Ernest M, 1986. "Resource Fungibility, the Flypaper Effect, and the Expenditure Impact of Grants-in-Aid," The Review of Economics and Statistics, MIT Press, vol. 68(1), pages 33-40, February.
    4. Philip J. Grossman, 1990. "The Impact of Federal and State Grants on Local Government Spending: a Test of the Fiscal Illusion Hypothesis," Public Finance Review, , vol. 18(3), pages 313-327, July.
    5. 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 126-140, February.
    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.
    7. repec:mpr:mprres:3216 is not listed on IDEAS
    8. Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(4), pages 1343-1373.
    9. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Schmid, Hillel & Dolev, Talal & Szabo-Lael, Rachel, 2010. "Community-based programs for children at risk: The case of budget flexibility in Departments of Social Services in Israel," Children and Youth Services Review, Elsevier, vol. 32(2), pages 178-184, February.
    2. Masayoshi Hayashi, 2011. "The effects of medical factors on transfer deficits in Public Assistance in Japan: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 287-307, December.
    3. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Vittoria Idrisova & Lev Freinkman, 2010. "Impact of Federal Transfers over Regional Authorities Behavior," Research Paper Series, Gaidar Institute for Economic Policy, issue 137P.
    2. Muhammed M. Islam, 1997. "On The Effects of Local Versus Central Government Financing of Local Services," The Review of Regional Studies, Southern Regional Science Association, vol. 27(1), pages 65-83, Summer.
    3. Dennis Patrick Leyden, 1992. "Donor-Determined Intergovernmental Grants Structure," Public Finance Review, , vol. 20(3), pages 321-337, July.
    4. Leah Brooks & Justin Phillips & Maxim Sinitsyn, 2011. "The Cabals of a Few or the Confusion of a Multitude: The Institutional Trade-Off between Representation and Governance," American Economic Journal: Economic Policy, American Economic Association, vol. 3(1), pages 1-24, February.
    5. Guy Gilbert, 1996. "Le fédéralisme financier, perspectives de microéconomie spatiale," Revue Économique, Programme National Persée, vol. 47(2), pages 311-363.
    6. Mark Duggan & Atul Gupta & Emilie Jackson, 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 111-151, February.
    7. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    8. Daniel E. Ingberman & Robert P. Inman, 1987. "The Political Economy of Fiscal Policy," NBER Working Papers 2405, National Bureau of Economic Research, Inc.
    9. Wallace E. Oates & Wallace E. Oates, 2004. "An Essay on Fiscal Federalism," Chapters, in: Environmental Policy and Fiscal Federalism, chapter 22, pages 384-414, Edward Elgar Publishing.
    10. Alberto Porto, 2004. "Finanzas Públicas Locales en la Argentina," IIE, Working Papers 057, IIE, Universidad Nacional de La Plata.
    11. Sungho Park & Craig S. Maher & Carol Ebdon, 2020. "Interlocal Collaboration and Local Fiscal Structure: Do State Incentives Matter?," Public Budgeting & Finance, Wiley Blackwell, vol. 40(2), pages 20-43, June.
    12. Worthington, Andrew C & Dollery, Brian E, 1998. "The Political Determination of Intergovernmental Grants in Australia," Public Choice, Springer, vol. 94(3-4), pages 299-315, March.
    13. Yu-Chu Shen & Karen Eggleston, 2009. "The effect of soft budget constraints on access and quality in hospital care," International Journal of Health Economics and Management, Springer, vol. 9(2), pages 211-232, June.
    14. Jeffrey Clemens & Stan Veuger, 2024. "Intergovernmental Grants and Policy Competition: Concepts, Institutions, and Evidence," NBER Chapters, in: Policy Responses to Tax Competition, National Bureau of Economic Research, Inc.
    15. Daysal, N. Meltem, 2012. "Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California," Journal of Health Economics, Elsevier, vol. 31(4), pages 545-563.
    16. Jeffrey Clemens & Benedic Ippolito, 2019. "Uncompensated Care and the Collapse of Hospital Payment Regulation: An Illustration of the Tinbergen Rule," Public Finance Review, , vol. 47(6), pages 1002-1041, November.
    17. Evgeny N. Timushev, 2017. "Flypaper Effect: Causes and Demonstration in the Budgetary System of Russia," Finansovyj žhurnal — Financial Journal, Financial Research Institute, Moscow 125375, Russia, issue 5, pages 60-70, October.
    18. Deller, Steven & Maher, Craig & Lledo, Victor, 2002. "Wisconsin Local Government, State Shared Revenues and the Illusive Flypaper Effect," Staff Paper Series 451, University of Wisconsin, Agricultural and Applied Economics.
    19. Lars Feld & Christoph Schaltegger, 2005. "Voters AS A Hard Budget Constraint: On the Determination of Intergovernmental Grants," Public Choice, Springer, vol. 123(1), pages 147-169, April.
    20. Baicker, Katherine & Jacobson, Mireille, 2007. "Finders keepers: Forfeiture laws, policing incentives, and local budgets," Journal of Public Economics, Elsevier, vol. 91(11-12), pages 2113-2136, December.

    More about this item

    Keywords

    Federalism; State and local budget and expenditures; Public health; H72; H77; I18;
    All these keywords.

    JEL classification:

    • H72 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Budget and Expenditures
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:ijhcfe:v:6:y:2006:i:3:p:237-258. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.