The Impact of Converting Categorical into Block Grants: The Lessons from the 314(d) Block Grant in the Partnership for Health Act

Abstract

Section 314(d) of P. L. 89-749, (1966), the Partnership for Health Act, combined nine categorical health grants into one block grant for health. The impact of section 314(d), according to data gathered for this study, can be summarized as follows: the block grant increased the administrative flexibility of state health officials; state health planning agencies generally did not have a major influence on the block grant; state health planning agencies located in governors' offices had less influence over the block grant than those located in state health departments; Congress did not significantly increase expenditures for the block grant; national influence was increased by creating health programs that could potentially have been made part of the block grant; and the block grant did not generally result in a reordering of spending priorities. The best explanation for the unspectacular effect of combining several categorical grants into one block grant was that, without new resources, the substantial (and welcome) new administrative flexibility given state officials was insufficient to produce an important substantive reordering of program priorities.