The map representing the Pittsburg Metropolitan Statistical Area (MSA) found on page 460 of our textbook provides some idea of inherent problems associated with urbanization and its encroachment upon the differing jurisdictions existing within all MSAs. While each local government may have specific issues that differ from other districts within an MSA, they also share problems as well. Noted on the map is that the Pittsburg MSA abuts the state of Ohio, however, what is not pointed out by the authors is that both the Wheeling and Steubenville-Weirton MSAs, located in the southeastern portion of Ohio and southwestern border of Pennsylvania, segue into West Virginia (Ohio Metropolitan Statistical Areas). This may give some idea concerning inherent problems, such as the example provided in the text related to Tennessee’s Memphis Regional Medical Center (“The Med”), where there exists no contingency for Medicaid reimbursements for healthcare services provided to residents living in Arkansas who are part of the same MSA (Smith, Greenblatt and Mariani 459). The problem described at the end of the paragraph above appears to be inherent to MSAs “Because these metropolitan areas span not just county but also state and even national borders, it is incredibly difficult to exercise any form of centralized planning over their growth and operation.” (Smith, Greenblatt and Mariani 462). Precedent appears to remain none existent to address the dilemma faced by The Med, where Medicaid reimbursements across state borders continue to be a contentious issue; and the proposition of incorporating those areas in Arkansas served by the hospital remains untenable because MSAs, as regions sharing essential services in this case, are not constitutionally... ... middle of paper ... ... today, it would be highly improbable that any movement attempting to consolidate geographic and political boundaries, as well as public services within those boundaries would be met with earnest bipartisan consideration, or by those having a vested interest in maintaining the status quo. Works Cited Bovbjerg, Randall R., Joshua M. Weiner and Michael Houseman. "State and Federal Roles in Healthcare: Rationales for Allocating Responsibilities." Federalism and Health Policy. Eds. John Holahan, Alan Weil and Joshua M. Weiner. Washington D.C.: Urban Institute, 2003. 25-57. Print. Smith, Kevin B., Alan Greenblatt, and Michele Mariani. Governing States and Localities. Third ed. Washington, D.C.: CQ, 2011. Print. "Ohio Metropolitan Statistical Areas (MSAs)." Workforce Development. Stark County. Web. 02 May 2012. .
The municipal system experienced a steady growth for several decades following the establishment of responsible municipal government in Ontario with the Baldwin Act of 1849 (Frisken 30). International interest was generated in 1954 with the creation of Metropolitan Toronto, the first major structural change in the system. Yet, it was not until’ 1967 that the Ontario Committee on Taxation recommended that the rest of Ontario be restructured in regional governments similar to the structure of Metropolitan Toronto (Frisken 30). As a result of the recommendation was the creation of ten regional...
Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.
Longest Jr., B.B (2009) Health Policy making in the United States (5th Edition). Chicago, IL: HAP/AUPHA.
cents” (Morris 23). According to this information, urban sprawl is costing tax payers in areas of
Discussion surrounding the role of the government in health care has become an American past time. The government is responsible for improving health care quality and safety in the United States which should enhance access to care. Many goals have been sought after since the enactment of the Patient Protection and Affordable Care Act (PPACA). Little achievement has been made in regards to which level of government is ultimately responsible for the continued support of health care. This essay will discuss both the state and federal level of government in health care, along with insight into the current happenings of both levels.
Berman, M. L. (2011). From Health Care Reform to Public Health Reform. Journal of Law, Medicine & Ethics, 39(3), 328-339. doi:10.1111/j.1748-720X.2011.00603.x
Medicaid is a broken system that is largely failing to serve its beneficiary’s needs. Despite its chronic failures to deliver quality health care, Medicaid is seemingly running up a gigantic tab for tax payers (Frogue, 2003). Medicaid’s budget woes are secondary to its insignificant structure, leaving its beneficiaries with limited choices, when arranging for their own health care. Instead, regulations are set in order to drive costs down; instead of allowing Medicaid beneficiaries free rein to choose whom they will seek care from (Frogue, 2003)
The state is responsible for the overall regulatory, supervisory and fiscal functions as well as for quality monitoring and planning of the distribution of medical specialties at the hospital level (Schäfer et al., 2010). The 5 regions are responsible for hospitals and for self-employed health care professionals, whereas the municipalities are responsible for disease prevention and health promotion rel...
Kevin B. Smith, Alan Greenblatt, and John Buntin, Governing states and localities: First Edition (Washington, D.C.: CQ Press), 2005, 95.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
Health reform and health policy has taken over in the United States in recent years. Medicaid is one of the top policies being implemented throughout our nation today. To understand how Medicaid and federalism cross paths with each other one must understand the basic definitions and concepts each one brings. Federalism is “system of government in which the same territory is controlled by two levels of government. Generally, an overarching national government governs issues that affect the entire country, and smaller subdivisions govern issues of local concern.” In short, federalism is a government system that has an overseeing central government over state government. While, “Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.” Medicaid is a test based welfare program for United States Citizens. Now the question is how does Medicaid intersect with federalism? These two intersect because Medicaid is a need-based program that is funded by the federal government and the state government and administered at the state level. The issue with Medicaid is that if it expands then a crowding-out effect may occur. Meaning, that the more the government spends on Medicaid then less they would be able to spend on other programs such as: education, transportation, or other state priorities. Medicaid is supposed to provide access to health insurance for approximately half of our nations uninsured citizens. Without Medicaid a vast amount of low-income citizens will go without having a healthcare insurance plan.
States in the recent years. The purpose of today’s health care is to manage costs while
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.
Our cities are not what they used to be. Over the corse of fifty years the once proud, strong, and viable hubs of American economic prowess are but a shell of what they were built for. The problems that many cities have are no longer condensed to their city limits and the sprawl that was created over that fifty year period is now threatening to enter the suburban spaces that were created when the city’s citizens left. The metro sprawl is starting to loose it’s attractiveness and unless there is more acknowledgment of the problems creeping out of these cities, the same declining trends will create unoccupied commercial and residential districts not unlike the downtowns of many American cities. Without careful discussion about these trends and our communities embracement of a more regional approach, then there will be more problems in less dense suburban areas, making those problems hard to correct. In order to prevent the spread of this urban blight and avoid low occupancy rates, communities must implement regional tax policies, plan for more effective use of space, and encourage smart growth.
...to. The notion is rather consistent to the already established idea that all local governments’ functions are and should be provided by either a municipal government or a county government. Without the procedures for city-initiated annexation and annexation powers, most of the urban services desired by and required for citizens would have to be provided by Guilford County. Lastly, as the local level of government in North Carolina, almost all governmental responsibilities have been vested in municipalities and county governments’ which are two types of general-purpose government units. Expenditures of local government units in North Carolina are made through cities and counties, whereas in many other states special districts are much more important. The result from this is that North Carolina’s urban areas do not have the likelihood of overlapping units elsewhere.