these inequalities in expenditure and resources are a cause for concern both in terms of the capacity of subsystems to deliver effective care and as a real problem in unequal care quality and availability for the population financial allocations to state health services from federal revenues are based on historical precedent not according to need furthermore once received by states there are few mechanisms to ensure that they are spent in ways that best meet local health care needs there are marked differences between states in the percapita resources available for providing the public health care services with rural areas facing particular problems of access