State and County Governments Play Complex Roles in Delivering Health Care Services

Analysis of the health care responsibilities of county governments

From September 1993 to April 1995, the National Association of Counties and the Institute for Health Policy at Brandeis University conducted surveys on the role of counties in delivering health care services.

According to 1990 figures, counties annually spend an estimated $22 billion of local tax revenues to support health and hospital services, yet their role in financing and delivering health care has gone largely unnoticed.

Key Findings

  • The surveys, conducted in each of the 48 states that have counties, asked about funding and delivery of health services; unfunded mandates and allocation of funds; and services areas including public, environmental and mental health. The surveys found:

    • State governments have prominent influence over country resource levels and service requirements.
    • The more distant a government responsibility is from direct interaction with individuals, the more likely it is to be a state rather than a county function.
    • Non-governmental contractors have become essential elements in the provision of services, but whether the state or county has the primary oversight responsibility remains unresolved.

    Survey findings offer policy analysts at the county, state, and national levels a better understanding of the role county governments play in delivering crucial health services and the relationship between state and county health systems.