Organization and Financing of Indigent Hospital Care in South Florida

By Catherine A. Jackson; Amanda Beatty | Go to book overview

SUMMARY

Over 700,000 persons living in south Florida lack health insurance. When uninsured persons require hospitalization, access to non-emergency care may be difficult. All south Florida hospitals provide care to the uninsured. Federal regulation, specifically the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA), requires all hospitals to provide emergency care regardless of the patient's ability to pay. Historically, tax-exempt hospitals provide care to the uninsured as a form of reciprocity for their tax exemption. In addition, social mores compel tax-exempt and tax-paying hospitals and community doctors to provide care to uninsured persons as well.

In Florida, local county government is responsible for providing health care services to uninsured, indigent persons. The state allows counties considerable leeway in how services are funded and provided. The three south Florida counties - Broward, Miami-Dade, and Palm Beach - have each established different local funding mechanisms and institutions to provide hospital care to the county's indigent.

The RAND Corporation was commissioned by the South Florida Hospital and Healthcare Association (SFHHA) to compare and contrast the health care systems in the three south Florida counties. The SFHHA was interested in understanding how local tax revenues were used to fund each county' s system, identifying the impact each system has on patients' geographic access to hospital care and, to the extent possible, assessing which system is most efficient. In making this request, the SFHHA was motivated by several issues. First, the three counties offered a natural experiment through which to study different approaches to financing and providing health care for the uninsured. Second, the Office of the Florida State Attorney General, while investigating the impact of the sale of two Palm Beach County tax-exempt hospitals to a forprofit chain, authored a report addressing local public funding of care for the indigent in these three south Florida counties. Commonly known as the deGroot report, named for the author John deGroot, the report motivated discussion among hospital managers and others about local policy regarding hospital care for the indigent. Third, SFHHA executive staff were familiar

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