GOVERNMENT HEALTH SPENDING IN THE AMERICAN WELFARE STATE, 1929-1981: A SOCIO-HISTORICAL ANALYSIS

摘要

While a substantial research literature exists on the development of social welfare spending in the United States, considerably less work has dealt with government spending in the health sector. This study focuses on the socio-historical determinants of health spending by the federal government and by a few selected state governments. Health expenditures are disaggregated into their three different and meaningful categories, health and medical services, medical facilities construction and medical research. The government's spending history in the health sector is also contrasted with the public provisions for education, veterans' programs, housing, social insurance, public aid, and other social welfare. A longitudinal, intra-national approach is used to explain what socio-economic, budgetary and political factors and which supply-side influences from the health sector shaped government health spending over time. Both of the theories of welfare state development, industrialization/modernization and partisan politics and political struggle, and the argument about medical professional control in the health sector itself are clearly important to understanding the unfolding of government health spending. Determinants of government health spending also work differently across levels of government. The dynamics of fiscal-authority sharing across levels of government are worthy of further attention. Especially compelling for future research, is the politicization of health spending taking place at the state levels of government.