Do Types of Public Services Matter? Evidence from the Expenditures of Direct versus Population-based Public Health Services in Georgia Counties

The American state of Georgia has a decentralized public health system, with county health departments providing services in cooperation with 18 regionally organized public health districts. Drawing upon the policy typology literature, this paper examines differences in public health expenditures on direct versus population-based services. For direct services that benefit particular individuals and groups, influences by local organized interests might be a relevant factor in the expenditure decision-making process. On the other hand, coordination at the district level is expected to be more important in population-based services which have spillovers across counties. An analysis using county-level expenditure data reports some supporting evidence.