DO DIFFERENT FUNDING MECHANISMS PRODUCE DIFFERENT RESULTS - THE IMPLICATIONS OF FAMILY-PLANNING FOR FISCAL FEDERALISM

The 104th Congress considered massive structural changes in federal ai d to the states. Not only would federal categorical grants be consolid ated 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 fa mily planning expenditures show that categorical funding (here, title X of the Public Health Service Act) is the most cost effective in prod ucing desired outcomes, such as lowering infant mortality. Policies us ing entitlement grants are generally more cost effective than those th at rely upon block grants. We discuss the implications of these findin gs for health policy more broadly and for fiscal federalism in general .