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administrative agencies Alviso ambulatory areas Baltimore City Hospitals budget categorical Cincinnati General Hospital city's CM CM community health centers costs CPPA Downtown Medical eligibility emergency room expenditures facility family planning federally funded financing fiscal five cities five study cities groups health and hospital Health Clinic health department health policy Homer G indigent inner-city inpatient institutions issue Louis major mayor Medicaid Medicaid program medical school Medicare ment MHSP Milwaukee County Municipal Health Services munity neighborhood health center operated outpatient patients percent pitals political population primary private physicians private sector problems public health department public hospital Public-General Hospitals Reagan reimbursement residents responsibility revenue role San Jose Santa Clara County serv service delivery social sources staff strategies structure teaching University of Cincinnati urban poor utilization Valley Medical Center visits voluntary hospitals welfare