Restructuring federalism: the impact of Reagan policies on the family planning program

The impact of disinvestment on alcohol and drug treatment delivery and outcomes: a systematic review

BACKGROUND

In the context of substantial financial disinvestment from alcohol and drug treatment services in England, our aim was to review the existing evidence of how such disinvestments have impacted service delivery, uptake, outcomes and broader health and social implications.

METHODS

We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42020187295), searching bibliographic databases and grey literature. Given that an initial scoping search highlighted a scarcity of evidence specific to substance use treatment, evidence of disinvestment from publicly funded sexual health and smoking cessation services was also included. Data on disinvestment, political contexts and impacts were extracted, analysed, and synthesized thematically.

RESULTS

We found 20 eligible papers varying in design and quality including 10 related to alcohol and drugs services, and 10 to broader public health services. The literature provides evidence of sustained disinvestment from alcohol and drug treatment in several countries and a concurrent decline in the quantity and quality of treatment provision, but there was a lack of methodologically rigorous studies investigating the impact of disinvestment.

CONCLUSIONS

This review identified a paucity of scientific evidence quantifying the impacts of disinvestment on alcohol and drug treatment service delivery and outcomes. As the global economy faces new challenges, a stronger evidence base would enable informed policy decisions that consider the likely public health impacts of continued disinvestment.

Do different funding mechanisms produce different results? The implications of family planning for fiscal federalism

The 104th Congress considered massive structural changes in federal aid to the states. Not only would federal categorical grants be consolidated into block grants, but entitlement programs would be converted to block grants too. Using family planning as a case study, this article examines whether program impacts change if different grant mechanisms are employed. Findings from a pooled time series analysis of state family planning expenditures show that categorical funding (here, title X of the Public Health Service Act) is the most cost effective in producing desired outcomes, such as lowering infant mortality. Policies using entitlement grants are generally more cost effective than those that rely upon block grants. We discuss the implications of these findings for health policy more broadly and for fiscal federalism in general.

Statutory coherence and policy implementation: the case of family planning

Policy theory suggests that coherent statutes – those with precise, clear goals, supported by an adequate causal theory, with clear administrative responsibilities, clear implementation rules, and assigned to committed agencies – are more likely to have their intended impact. Using the Mazmanian and Sabatier policy implementation framework, this article examines U.S. family planning policies with a pooled time series analysis from 1982 to 1988. Of the four family planning statutes, only Title X, the categorical grant program, meets the criteria of a coherent statute. The data analysis reveals that a dollar spent through Title X has a much greater impact on birth rates, abortion rates, late prenatal care, and infant and neonatal mortality than does a dollar spent through other programs. The results are strong evidence in support of designing policies with coherent statutes.