Unless alternative funding is anticipated, the plan is likely to grind into a halt. Extra guaranteed funding can be sought from donors who may wish ton fund the plan for a given number of years or incorporate the NGOs into the plan such that their contribution will help make the plan successful. Further, cost sharing can be seen as a logical route to take at the moment due to the unpredictability of the plan’s revenue base. Unclear Future Any plan that operates so far should have the potential to be sustainable without too much of over careful fiscal management and strict legislation on eligibility.

However, this is not the case for the health care plan in Hillsboro because the logistics have to balance. The ever shrinking revenue base, calls for restrictive measures supported by the reasoning that it is better that the plan is able to accommodate a limited number of beneficiaries who it can comfortably support than to allow for oversubscription which may lead to fiscal deficits. It therefore manages these logistics by being keen on eligibility thus keeping out residents in need of the plan coverage. Recommendations

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Seeking alternative funding of the plan will not only help make the plan predictable but will also see it relax its strict legislation on legibility and the plan’s over careful fiscal management both of which will go a long way to ensure the expansion of the plan’s beneficiaries. Political Dependence All along since the inception of the healthcare plan in Hillsboro in 1991, we have witnessed periods of growth and shrinkage alternatively. These alternating episodes of growth and shrinkage coincide with the political election of the county’s government.

It has therefore been very clear that the wellbeing of the healthcare plan depends on the politicians or rather lies on the hands of the political leaders of the day who may then choose to support it or otherwise, increase the provision to a full cent sales tax or reduce it from half to one quarter of a cent sales tax etc as they best deem based on whether they support the program or not. Therefore the politicians of the day call the shots and thus determining the health wellbeing of the poor Hillsboro residents uncovered by other programs or arrangements such as Medicare or Medicaid.

Recommendations The best way to go about this is to ensure that the county government privatizes the healthcare plan such that the county government will be tied to give the half cent or full cent sales tax no matter what for a given fixed period of time say 10 years such that there is strategic planning to fully understand the dynamics of the plan which are otherwise quite difficult to understand if some variables such as fixed financial or revenue base or fixed policy influence from the private mangers and not the politicians etc.

Increasing Costs The costs of the beneficiaries per month especially on prescription keeps on increasing now and again thus falling out of touch with the revenue base. If such dynamics i. e. revenue and costs fail to resonate in sync, then there is a danger in making the program non functional or even becoming a white elephant for that matter hence exposing the lives of the poor Hillsboro residents who are not legible for other covers to uncertainty. The economic crisis in the US has also dome a lot to contribute to the increasing cost.

Besides the economic crisis, the cost of medical or health care in general in the US has assumed an increasing trend since the early 90s thus calling for reasons to worry of the future sustainability of the plan Recommendations The funding of the program should be proportional to the financial dynamics. The county, as recommended above needs to privatize the program, seek alternative funding especially from donors and continue to increase the percentage of sales tax allocations to the program so that the issue of increasing costs can easily be countered.

References Cimasi RJ, (2005): The U. S. Healthcare Certificate of Need Sourcebook, Published by Beard Books, p122 Brown L D, (2006): Impermanent Politics: The Hillsborough County Health Care Plan and Community Innovation for the Uninsured, Project Hope, retrieved on 29th January 2009 from http://content. healthaffairs. org/cgi/content/full/hlthaff. 25. w162v1/DC1