Block Grants and State Discretion: A Study of the Implementation of the Partnership for Health Act in Three States

This article examines the use of federal funds provided to state health departments under a grant consolidation of eight previously categorical health programs in Michigan, Pennsylvania, and Alabama in a comparative context. The primary question addressed is why the three states chose to describe th...

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Bibliographic Details
Published in:Policy sciences 1981-04, Vol.13 (2), p.153-181
Main Author: Greenberg, George D.
Format: Article
Language:English
Subjects:
Alabama/Alabaman/Alabamans
Allocation
Block/Blocks
Budget allocation
Budget appropriations
Collaboration
Department/Departments/ Departmental/ Departmentalization
Federal budgets
Federal funds
Funding
Grant/Grants
Grants
Health care administration
Health legislation
Health policy
Health/Healthy
Local government
Michigan
Pennsylvania/Pennsylvanian/ Pennsylvanians
Public expenditure
Public health
State/States
U.S.A
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Summary:This article examines the use of federal funds provided to state health departments under a grant consolidation of eight previously categorical health programs in Michigan, Pennsylvania, and Alabama in a comparative context. The primary question addressed is why the three states chose to describe their allocations of funds within the total health department budget differently, and what political, administrative, and bureaucratic factors explained the differences. Although certain factors were found to be at work in all states (e.g. each had an incentive to concentrate the reported use of federal funds to simplify federal audits) these factors combined with circumstances unique to each state to produce different expenditure patterns. After examining the experience of three states, general hypotheses are developed. For example, it is hypothesized that more volatile changes in allocations will result from grant consolidations in policy areas which do not address basic service needs. Finally the decision-making process with respect to block grant funds is characterized as one in which a small group of professionals determined allocations autonomously with relatively little input from interest groups or other actors within state government; nevertheless, the external political and administrative environment severely limited the possibilities of realistic choice in each of the three states studied.
ISSN:0032-2687
1573-0891
DOI:10.1007/BF00136007