USF St. Petersburg campus Faculty Publications


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

SelectedWorks Author Profiles:

Richard B. Smith

Document Type


Publication Date


Date Issued

January 2006

Date Available

October 2011


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.


Abstract only. Full-text article is available only through licensed access provided by the publisher. Published in International Journal of Health Care Finance and Economics, 6, 237-258. doi: 10.1007/s10754-006-9003-6 Members of the USF System may access the full-text of the article through the authenticated link provided.




Kluwer Academic Publishers

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.