State efforts to expand health coverage: One bite at a time

For more than twenty years, health scholars and advocates have warned us about the lack of adequate health coverage among a growing number of Americans. Health insurance premiums are rising. Many employers, especially small employers who employ over half of the country’s workforce, and individuals are seeing premium increases of 30, 40, and even 50 percent. Not surprisingly, America’s uninsured population is rising— to more than 41 million people. States are feeling the budget crunch as the economy sags and more and more people turn to state Medicaid and other public health care systems. This all means that state policy makers are looking for solutions. Yet no consensus has emerged on what to do about the uninsurance problem. Conservatives propose encouraging individuals to buy private health insurance and place more reliance on market forces. Liberals continue a struggle initiated during the New Deal to provide publicly financed health coverage

Risky business: Effectiveness of state market-based health programs

Since the 1990s, state governments have been leaders of health care reform. Today, approximately 47 million people are without health insurance. As health care costs and uninsurance levels continue to rise, states are pursuing a variety of government- and market-based strategies to address this growing social problem. Health care research has indicated that state-based programs have proven to be successful in extending access to coverage. However, the question remains as to whether the market-based programs have had a positive impact on state health care. Advocates for market-based state health programs argue that the reforms benefit the greater good because they serve an economic development function by improving the economic productivity and overall health of state citizens. Whether market-based policies are accomplishing these goals is a matter of debate. This study examines the effects of the various market-based state policies. The evidence generated by this research sheds light on the societal effectiveness of market-based health care strategies used by state governments. The results of our analysis indicate that programs enacted by states to promote increased access to medical care have developmental effects beyond the client population directly served

One year after Katrina: Tragedy of the Crescent City

One year after Katrina, New Orleans and the surrounding area are slowly showing signs of growth and a return to normalcy. Two recent studies provide excellent overviews of the economic impacts the hurricane had on the area as well as the efforts New Orleans has made to recover from the storm’s devastation. The first study which was published in August of 2006 was done by the Brookings Institution. A “Special Edition of the Katrina Index: A One-Year Review of Key Indicators of Recovery in Post-Storm New Orleans” by Amy Liu, Matt Fellowes and Mia Mabanta, provides an overview of key social and economic indicators on New Orleans’ progress since the storm. The other study, published in June 2006, “Advancing in the Aftermath II: Tracking the Recovery from Katrina and Rita,” by Dr. Loren C. Scott, provides an extremely detailed account on the progress of recovery in the four MSAs along the Gulf Coast. In this brief article, we summarize key economic indicators and look at how the city and region’s economy has been impacted by the storm and its progress since. We rely heavily on these two studies and recommend them as outstanding sources for the economic impact the hurricane had on New Orleans

Spatial Deconcentration of Tourism Concentrations: A Visitors’ Galaxy Impact Model of the COVID-19 Crisis

This paper analyzes the impact of COVID-19 on mass tourism concentrations, such as Las Vegas. It argues that health risks and perceptions may induce a more deconcentrated pattern of mass tourism, with more geographical dispersion to rural and natural areas. The analytical framework is modeled and applied to extensive data on Las Vegas tourism. The proposition on deconcentrated tourism concentrations is confirmed. Pre-pandemic outer-inner city complementary relations between “Outdoor Activities” in 11 surrounding national parks and the “Gaming Industry” in Las Vegas have transformed into outer-inner city substitution relations in the COVID-19 pandemic. This represents the evolving deconcentration of tourism concentration facing the growing uncertainty in an inner-city due to health risks in a pandemic. Availability of diversified tourism resources may dampen the shock to a concentrated tourism destination such as Las Vegas when effectively linked to the decentralized but easily accessible tourism resources in dispersed rural and natural areas

The relationship between news media coverage and people volunteering for clinical trials

In academic medical centers an untested assumption is that positive media attention aids recruitment of patients into a medical study while negative news reporting is damaging. In this study we examine associations between the amount of newspaper coverage concerning medical research and the number of people who volunteer, and the positive or negative content of the reporting. We find evidence that a positive relationship, though not statistically significant, exists between the volume of media coverage and volunteerism; a positive relationship exists between positive media coverage and volunteerism; and no existence of an inverse relationship between negative news coverage and volunteerism. These results lay a foundation for more in-depth exploration into the role news media play in this type of volunteerism

The chicken or the egg: A recent history of public opinion and tax reform in Florida

Public dislike of taxes led to tax revolt and tax reform. Despite the connection between tax attitudes and tax policy, relatively little is known about public attitudes toward taxes over time, and how public opinion either shapes or is shaped by changes in tax policy. We examine the link between opinion and changes in tax policy in Florida, where the public’s view of sales and property taxes was surveyed consistently from 1979–1997, a time when both taxes changed significantly. This combination of tax reform and survey data allows us to observe the pattern of public opinion before, during, and after changes in tax policy, and to draw inferences about whether public opinion leads or lags state action, while examining common explanations for individual differences in opinion. Among other things, our results indicate that the portrait of an anti-tax populace is overdrawn and that the pattern of opinion differs for each tax

Predicting turnover of appointed county managers in large American counties

Researchers have suggested that American counties are emerging as leaders in local governance. This is mainly attributed to counties being called on to provide a whole host of new services to an ever-growing population. County managers are known to play a critical role in the provision of these services. Thus, the extent of turnover among county managers can significantly affect the services provided to a community. To date, researchers know very little about the factors contributing to county manager turnover. Several empirical analyses have explored tenure and turnover patterns of top-level government executives, yet these analyses have principally focused on cities. The purpose of this article is to extend existing research on city and county manager turnover. In this study, the authors test hypotheses with data on county manager turnover from 32 large counties with populations greater than 500,000 over a period of 15 years (1992-2006). As with prior studies performed on city manager turnover, the authors posit that county manager turnover in counties with a commission–manager form of government are influenced by forces of political uncertainty, fiscal stress, and community instability. The results show that increases in measurements of political uncertainty, fiscal stress, and community instability positively influence county manager turnover. Furthermore, the results show that increases in a county manager’s level of formal education increase the odds that a county manager will remain in office. Similar increases were found when county managers who were promoted from within the organization were compared with those who were recruited from external sources

What cannot be counted: Ethics, innovation, and evaluation in the delivery of public services

For the past 20 years, outcome evaluation has been one of the most significant innovations in the delivery of public services and the management of nonprofit organizations. Theoretically evaluation is meant to provide an engine to innovate existing programs and organizations by providing actionable information. Much of the existing research has primarily been focused on compliance with mandated program performance evaluations with little consideration to the implications of these mandates. In the nonprofit setting, administrators often must choose between spending money on achieving the mission or contracting out to acquire the expertise necessary to adequately measure performance toward achieving that mission. The irony is that accountability requirements can affect the organization‟s ability to achieve its mission because it can hinder a nonprofit employees‟ capacity to provide services to clients. This generates an ethical dilemma for individuals within these agencies when they are forced to choose between a client‟s needs and organizational performance demands. This paper analyzes the inherent dilemmas that stem from accountability systems implemented by nonprofits providing direct services. The research employs the Right-versus-Right construct developed by Rushworth Kidder (2005) and examines the moral dilemma surrounding the mandates of performance evaluation and the impact on ethical decision-making and management. These theoretical constructs aid in the identification of ethical and management dilemmas as they relate to performance evaluation and the impact on an organization‟s mission, management, and values. This assessment is especially timely given the recent economic crisis, which has created an increased demand for services with fewer resources to meet additional service demands

Spatial Deconcentration of Tourism Concentrations: A Visitors’ Galaxy Impact Model of the COVID-19 Crisis

This paper analyzes the impact of COVID-19 on mass tourism concentrations, such as Las Vegas. It argues that health risks and perceptions may induce a more deconcentrated pattern of mass tourism, with more geographical dispersion to rural and natural areas. The analytical framework is modeled and applied to extensive data on Las Vegas tourism. The proposition on deconcentrated tourism concentrations is confirmed. Pre-pandemic outer-inner city complementary relations between “Outdoor Activities” in 11 surrounding national parks and the “Gaming Industry” in Las Vegas have transformed into outer-inner city substitution relations in the COVID-19 pandemic. This represents the evolving deconcentration of tourism concentration facing the growing uncertainty in an inner-city due to health risks in a pandemic. Availability of diversified tourism resources may dampen the shock to a concentrated tourism destination such as Las Vegas when effectively linked to the decentralized but easily accessible tourism resources in dispersed rural and natural areas

Turnover among city administrators: The role of political and economic change

Executive turnover can have profound effects on city policies, programs, and commitments such as contracting or issuing debt. This article identifies how political changes, reflected in the composition of the city council, and economic changes in the community influence city manager turnover. Analysis of manager turnover patterns in 143 large U.S. cities with council-manager governments from 1987 to 1999 allows us to distinguish “push” and “pull” factors that can induce city managers to leave their jobs. The empirical analysis demonstrates that political conflict and economic development can influence the likelihood that a city manager will exit a community, but these effects can be complex. In particular, the influence of community economic development on turnover includes a temporal dimension not revealed in previous research. We conclude by discussing the findings’ implications for career patterns in city management