This chapter shows how the paternalist policy style impacts social policy implementation at the provincial level and below. The top-down approach in paternalist provinces produces relatively standardized social policy but reduces opportunities for officials to innovate and tailor policies to local conditions. Fiscal transfers from the center often foster corruption and dependency in these provinces. Thus, many paternalist provinces have experienced rising inequality despite targeted policies and transfers. While focusing on health policy in paternalist provinces, this chapter also discusses the impact of paternalism on education, poverty alleviation, and housing.