政府权力下放对加利福尼亚州无保险人群县级医疗支出的影响。

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

作者信息

Scheffler Richard, Smith Richard B

机构信息

Health Economics and Public Policy, School of Public Health and Goldman School of Public Policy, University of California, Berkeley, USA.

出版信息

Int J Health Care Finance Econ. 2006 Sep;6(3):237-58. doi: 10.1007/s10754-006-9003-6. Epub 2006 Sep 26.

DOI:10.1007/s10754-006-9003-6

PMID:17001535

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.

摘要

我们分析了加利福尼亚州1991年将健康、心理健康和社会服务控制权从州下放到县的“项目重新调整”政策。借鉴关于政府间转移支付的经济学文献，并使用为本研究构建的数据，我们分析了“重新调整”对未参保人群医疗支出的影响。我们发现，权力下放后各县在贫困人群医疗服务支出模式上发生了变化。然而，我们的结果表明，县级政府对社会服务支出保持着一定程度的投入，而最近的研究表明，州政府层面可能缺乏这种投入。