Case Analysis: Emerging US Health Care System

Case Analysis: Emerging US Health Care System

Many people regard Hillsboro County as a comfortable place to raise a family. It is an area known for its social and economic stability. While the residents are generally aware of national and world events, the local media coverage is dominated by news about the area’s youth teams, social and fraternal organizations, church outings, and high school sports. Multiple gen- erations of families live in Middleboro and the surrounding towns that make up Hillsboro County. Case Analysis: Emerging US Health Care System

demogrAphic chArAcTeriSTicS Middleboro and Hillsboro County are classifi ed as non–metropolitan areas. Middleboro has been the economic, political, and social hub for Hillsboro County. Th e average family size is 2.57 people. Basic demographic data are given in tables 1.1 through 1.3 at the end of this case. (Note that the entire casebook is set at the start of 2020, so all tables are dated for the preceding years.)

Th e other major town in Hillsboro County is Jasper, located 23 miles southeast of Middleboro. Jasper is a growing community that benefi ts from being close to Capital City, the state capital. Jasper is becoming a bedroom community for Capital City and is continuing to develop as an economy that is independent from Middleboro. Case Analysis: Emerging US Health Care System

Middleboro is 45 miles northwest of Capital City and 70 miles east of University Town, the location of State University. Access to Middleboro is limited to rail (freight), bus, automobile, and truck. The majority of private and commercial travel is done on the auxiliary four-lane, east–west interstate highway, which is typically closed an average of three days per year because of weather conditions. Commercial air travel is available in Capital City. The mountains on the east and west make winter travel outside Middleboro especially difficult. The fertile valleys on the north and south are known for agricultural activities.

Outside of Middleboro and Jasper, the population lives in small, scattered villages. The only transportation linkages to Middleboro from these scattered communities are the rural county and state highways. Limited bus service is available throughout Hillsboro County. Middleboro serves as the regional transportation hub, and the bus station in Middleboro offers connections to major population centers in the state. Jasper is also served by this bus system. Recently, a commuter bus system began linking Jasper with Capital City.

Hillsboro County stretches 45 miles to the north, 15 miles to the west, 28 miles to the east, and 37 miles to the south of Middleboro. Seventy-one percent of the total area is developed, and the remainder is taken up by forest, the state park, and rivers. This area experiences four distinct seasons, but tourists find it especially attractive during the fall and spring. Sports of all types play an important role in the life of its communities. Table 1.4 indicates the miles between the communities located in Hillsboro County. Case Analysis: Emerging US Health Care System


Middleboro is located along Swift River, which was instrumental in the commercial development of the city in the early 1800s. Before the turn of the century, Swift River and the commercial barges that traversed it were the city’s primary linkage with the rest of the state. Now the river is used for recreational purposes, and some limited redevelopment of the riverside property has begun.

Swift River divides Middleboro into two almost equal parts. The north side of the river is the site of the central business district, large manufacturing plants, the railroad station, older residential neighborhoods, and the county government. During the 1970s, federal funds were used to develop low-income housing on the north side. The south side of the river, which is closer to the interstate highway, is the site of newer residential neighborhoods, the new Middleboro High School, and small shopping centers. To date, the City of Middleboro has not approved any significant development—residential or commercial—in the vacant 150-acre land adjacent to the interstate highway. Case Analysis: Emerging US Health Care System

The median education level of the population older than 25 years is 10.7 years. Approximately 13.5 percent of the population has completed college, and 89.3 percent has completed high school. The current dropout rate from area high schools is 3 percent, an improvement over the 17 percent rate experienced 20 years ago.

Middleboro is the site of numerous elementary schools (K–6), a regional middle school (7–8), and a high school (9–12) that serve students from all over the city. Other communities in the county can send their children to Middleboro schools, using tuition arrangements on a space-available basis. Although all the schools are owned and operated by the City of Middleboro, a separately elected Middleboro School Board makes educational policy. One-third of the nine-member school board is elected each year in a special school- district election held in Middleboro. Each year, the school board submits a recommended budget for consideration by the Middleboro City Council. The city council approves the school budget before it is submitted, as part of the town’s total budget, for voter approval. All employees of the Middleboro School Department—except the school superintendent Dr. Sam Drucker—are unionized. Abby O’Hara is currently the chair of the school board, a position she has held for the past ten years. The new $28.5 million high school located in Middleboro opened last year after being considered by the city council for about eight years. The town is heavily involved in high school sports. Middleboro Memorial Stadium is a landmark in regional high school football. Case Analysis: Emerging US Health Care System

Jasper is the site of numerous elementary schools, a regional middle school (5–8), and a high school (9–12). A state-supported junior college is scheduled to open. A five- member elected school board that is independent of the town governs the Jasper Regional Educational Cooperative. Each year, this school board submits a recommended budget directly to the voters. Once approved, the funds are collected by the Town of Jasper from local taxes. The Jasper Regional Education Cooperative has expressed interest in working with the state to develop a regional vocational high school to complement the new Hillsboro County Junior College Case Analysis: Emerging US Health Care System

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