Pennsylvania, followed by a group spending around $8-9 billion in 1999, namely
Florida, Illinois, Massachusetts, Michigan and Ohio. Of interest are the ways in
State State Funds ($ million) Federal Funds S/F Ratio GDP Share
New York |
$15,009 |
$14,860 |
99% |
3.9% |
California |
$14,412 |
$11,981 |
86% |
2.1% |
Texas |
$ 6,993 |
$ 8,100 |
115% |
2.2% |
Pennsylvania |
$ 6,723 |
$ 6,110 |
90% |
3.3% |
Florida |
$ 5,080 |
$ 4,469 |
80% |
2.2% |
Illinois |
$ 5,536 |
$ 3,860 |
70% |
2.1% |
Massachusetts $ 5,125 |
$ 3,279 |
63% |
3.4% | |
Michigan |
$ 4,739 |
$ 4,231 |
89% |
2.9% |
Ohio |
$ 6,739 |
$ 1,620 |
24% |
2.3% |
New Jersey |
$ 4,522 |
$ 2,971 |
66% |
3.9% |
Table 2: State & Federal Health Expenditure, USA Top Ten, 1999
Source: Calculated from Milbank Memorial Fund & US Dept. of Commerce, Bureau
of Economic Analysis
which such budgets are composed such that variance from the US mean GDP share
per State (2.6%) is relatively small, including the rest, where West Virginia at 4.8%
on the one hand, and Alaska at 0.6% are among the most significant outliers. With a
few exceptions, such as Ohio in Table 2, Federal funding makes a significant
contribution. Texas, like other southern Appalachian and south-western States receive
more Federal than State disbursements.
However, calculations of such disbursements in relation to State population size show
New York, at $1,572 per capita, and Massachusetts, at $1,482 to be the most generous
spenders, Pennsylvania comes next, at $1,070, then New Jersey at $949, Michigan at
$897 ahead of California at $800, followed by Illinois ($783), Texas ($765), Ohio
($763) and Florida ($615). Linking back to points made earlier about the increasing
‘commoditisation’ of health care in the US (and to a growing extent in the UK and
perhaps elsewhere) States such as these are becoming active purchasers of higher
quality, more technology-intensive, but also value for money health services. It should
further be recalled that the statistics under discussion constitute only some 20% of
total State health care budgets, but represent baseline funding. Clearly, California is
12
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