Public policy and health resource distribution

Despite federal health programs of the thirties, the Great Society programs and the establishment of health planning agencies in the sixties, health resources continue to accumulate in wealthier areas. According to a rational decision-making model public resources would be expected therefore to be directed toward those poorer areas with perceived needs. This paper explores the distribution of public and private health resources among towns of Connecticut. Using a rational decision-making model, the distribution of these resources is tested in a series of stepwise regression equations against the socioeconomic and health characteristics of the population. Private allocations of health resources (such as physician distribution) respond to socioeconomic factors while public resources do not show a clear pattern of overcoming the maldistribution effected by private actions. We find little evidence to support the hypothesis that Connecticut's town and state decision makers in health were following a rational model such as is the basis for health planning. Some other more complex model, such as a bureaucratic politics model, would explain better public policy decisions in health resource allocation.Research for this paper was carried out under Department of Health, Education, and Welfare Grant #5-R01-HS-00900. We wish to thank Berton Freedman for assistance with computer programming, and our former Yale Health Policy Project colleagues, George A. Silver, James Warner Bjorkman, and Christa Altenstetter for comments on an earlier draft. This earlier paper entitled Socio-Economic Indicators, Health Resources and Health Status: A Statistical Analysis and its Policy Implications was presented to the Statistics Section, American Public Health Association Meetings, November 16–20, 1975, Chicago, Illinois.