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Private Financing and the regulation of health care : the United States experience.
The United States health care System is distinguished by a relatively large share of expenditures made in the private sector. However, despite some popular beliefs, this large role for private financing has not been associated with freedom from regulation. Private purchasers of care, including businesses and unions, are increasingly concerned with controlling costs. This has transformed the private health insurance industry from a System whose major purpose was to raise revenues for hospitals to one whose principal product is an ability to control medical care utilization by monitoring and regulating physicians behavior.
This change in the industry is related to four trends — the use of experience rating, the participation of private firms in government programs, the growth of self-insurance, and vertical integration of insurers and providers. In addition, the recent substantial increase in the supply of physicians has weakened the previously strong political and economic position of the medical profession and made doctors more vulnerable to competitive pressures.

The study of public sector budgeting, particularly at the state level, has been dominated by incremental models of decision making. As a result, the budget has not always been viewed as an effective management tool for governors and other senior state officials. However, there are several critical issues which state leaders repeatedly face and for which the budget is the principal instrument for implementing decisions. This article identifies four key issues for the strategic management of state government and relates alternative approaches to each issue to the nature of budgetary politics. The first section raises the issues in the form of four questions. The next sections present alternative answers and discuss their political implications. Where appropriate, examples from the state of New York are included.

Contents -- List of Tables -- List of Figures -- 1. Introduction // Gerald Benjamin and Charles Brecher -- 2. A Comparative View // James C. Musselwhite, Jr. -- 3. The Economy // Matthew P. Drennan -- 4. Population // Katherine Trent and Richard D. Alba -- 5. The Political Relationship // Gerald Benjamin -- 6. The Electoral Framework // Martin Shefter -- 7. The City and the State in Washington // Sarah F. Liebschutz -- 8. Public Finance // Cynthia B. Green and Paul D. Moore -- 9. Capital Projects // James M. Hartman -- 10. Human Resources Management // Raymond D. Horton and David Lewin

Medicaid's transformation since its inception rivals the biological changes of metamorphosis, and this process is not yet over. Past metamorphoses include the change from a small program with eligibility linked to the states' cash welfare benefits to one with national eligibility standards covering many not receiving cash benefits; from a traditional fee‐for‐service payment program to one dominated by capitated managed care arrangements; and, under the Patient Protection and Affordable Care Act of 2010, to a widely accepted component of a national system for near‐universal insurance coverage. An analysis of the forces behind these significant changes suggests that future transformations are likely. Four potential scenarios are presented and assessed.

Collaborations between nonprofit and public sector organizations have become an increasingly important phenomenon in state and local public service delivery since the publication of the Winter Commission report in 1993. This article focuses on one of the less studied types of public–nonprofit collaborations, those in which philanthropic support from nonprofit organizations supplements the resources and activities of public agencies. Drawing on the case of "nonprofit‐as‐supplement collaborations" that support park services in New York City, this article documents the benefits and drawbacks associated with such collaborations. While they can provide increased resources and encourage management innovations, they also can lead to inequities in the availability and quality of services, the preponderance of particularistic goals over the broader public interest, and the politicization of previously bureaucratic decision making. The authors offer two strategies for public managers to realize more effectively the benefits yet mitigate the shortcomings of these collaborations.