Local governments have a large and growing role in national health care, and they must be included in any plans for implementing reforms. Whether policies and standards are set by the federal and/or state governments, local governments deliver many health services, especially those directed at vulnerable populations.

Unless local officials are involved early in planning for implementation of health care reforms, unnecessary delays and problems may result, with serious effects on people who depend on local governments for health care services.

Types of Expenditures

Local governments spend an estimated $85 billion per year on health care, based on the latest years for which information is available. This means that 1 of every 8 dollars spent by local governments is for health-care related activities! This spending includes (1 ) protecting the health of the community, (2) providing health care for low- income and uninsured residents, (3) providing health benefits for employees and retirees, and (4) helping states finance Medicaid.

Local spending on health services is a large and rapidly growing budget component. Hospitals and public health were the two fastest growing services of local government, far exceeding the overall 4.9 percent increase in spending.

Local governments have a large and growing role in national health care, and they must be included in any plans for implementing reforms to that system. While overall policies and standards may be set by the federal and state governments, it is local governments that deliver many health services and need to be considered in implementing any reform of national health care systems What is the author's purpose?