Medical underservice: The source and the potential of the special district solution

This paper is concerned with the appropriateness of various structural approaches t o the problem of medically underserved areas (MUAS). The failure of the private sector in this regard and the experience with public sector responses to the problem are noted. The paper compares the merits of applying the device of the special district to MUAs with arguments favoring a general government solution. The experience of the state of Arizona with Health Service District legislation is observed.

The logic of the special district and the nature of medical underservice offerslim hope that this device might materially ameliorate the problem. A t the same time, the past initiatives of general purpose government have not served t o erase medical underservice. The point is made t h a t empirical evidence is needed t o fully test the assumptions underlying the arguments of the respective approaches.     

The Current Status and Roles of State Advisory Commissions on Intergovernmental Relations in the U.S. Federal System

During the 1970s and 1980s, a number of states created entities commonly called advisory commissions on intergovernmental relations (ACIRs). Although as many as half the states at one time or another supported an ACIR, only about 10 do so today. Relying on face‐to‐face and telephone interviews, e‐mail correspondence, website analysis, and mailed surveys of directors and other staff members of active and terminated ACIRs, this study reports on the organization and structure, staffing and finances, and activities and performance characteristics of the state ACIRs still viable today. The study attempts to identify factors that seem most related to successful performance of these agencies, as well as to the termination of the agencies. In conclusion, it speculates on the continued role of state ACIRs.