1983 Study: Indigent Health Care
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'"' .,. - ~ .. -- Indigent Health ~are study "-'" c,O"'MUN/~ ~ y III r-~ "~ ~ t ~ ~ ~ u ~ I ~ ~~ .f) A Report to the Citizens of Jacksonville. Fall 1983 EXECUTIVE SUMMARY Because Jacksonville has a greater percentage of poor residents than either the state or the U.S" financing health care for the medically indigent is of considerable concern to local policy makers. About 16% of Jacksonville's residents survive on an income of less than federal poverty level guide- lines. An additional 5% of Jacksonville's population earn only slightly more than the poverty level. Jacksonville's per capita income is lower than that of the state and nation and recent economic down- turns have increased the number of persons without job-related health insurance. Each year the city negotiates an Indigent Care Agreement with University Hospital which provides health care for medically indigent persons. In 1983 the city will pay $16.7 million to the hospital for this purpose. In -addition, other local hospitals, physicians and programs provide some medical services at little or no cost to indigent persons. ~ The indigent are more Iikely to have poor health that the rest of the population, and it is harder for them to obtain medical care. Complicated eligibil1ty requirements for the numerous medical assistance programs are difficult to understand. Indigent persons are often hindered from receiving required medical care because of transportation problems. Health care professionals and institutions are often reluctant to accept payment- from Medicaid and Medicare because of the slowness of the system and the costs associated with preparing paperwork to request payment from these programs. In some cases, the manner in which services are provitJed to indigent persons influence them to amid them. The study recommends decentralizing some of University Hospital's services by developing primary health care clinics at several of the existing public health clinic sites in Jacksonville. Such clinics should be staffed by personnel from University Hospital, the Public Health Division and other medical personnel from the community. Jacksonville lacks a coordinated health planning mechanism for the medically indigent. University Hospital, Public Health and Visiting Nurse Association each receive city funds for provision of certain hea Ith ca re se rvices to the ind igent, but these agenc ies do not engage in fo rma I coope rat ive plann ing. The study recommends that such a formal cooperative relationship be established between these agen- cies to plan for continuity of indigent care. In addition, the study recommends that city government designate a mechanism through which it can receive recommendations regarding the provision of health care to the indigent in Jacksonville. National economic forces, such as inflation, influence the local delivery of health care. The public has increasingly demanded high quality health care. Government has assumed some responsibility for provision of medical care to the indigentuprimarily through MediCaid and Medicare--but these programs cover only part of the costs of such care. Health care subsidies (cost-shifting) are con- cealed in hospital, physician and insurance bills of other (paying) patients in order to allow health care providers to net sufficient income for operation. Enhanced funding of Florida's Medicaid program is important. Increasing concern about medical malpractice claims has resulted in physicians often ordering unnecessary medical tests to protect themselves in case of suit. Such practices result -"'-.-/ in higher health care costs for everyone. The study reconmends state legislation to reduce the financial malpractice risk of health care personnel who might otherwise donate services to the indi- gent.
description
1983 Study: Indigent Health Care
Transcript of 1983 Study: Indigent Health Care
'"'
.,. -~..
--
Indigent Health ~are
study"-'"
c,O"'MUN/~~ y
III r-~ "~~ t~ ~ ~u ~ I ~
~~ .f) A Report to the Citizens of Jacksonville. Fall 1983
EXECUTIVE SUMMARY
Because Jacksonville has a greater percentage of poor residents than either the state or the U.S"financing health care for the medically indigent is of considerable concern to local policy makers.About 16% of Jacksonville's residents survive on an income of less than federal poverty level guide-lines. An additional 5% of Jacksonville's population earn only slightly more than the poverty level.Jacksonville's per capita income is lower than that of the state and nation and recent economic down-turns have increased the number of persons without job-related health insurance.
Each year the city negotiates an Indigent Care Agreement with University Hospital which provideshealth care for medically indigent persons. In 1983 the city will pay $16.7 million to the hospitalfor this purpose. In -addition, other local hospitals, physicians and programs provide some medicalservices at little or no cost to indigent persons.
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The indigent are more Iikely to have poor health that the rest of the population, and it is harder forthem to obtain medical care. Complicated eligibil1ty requirements for the numerous medical assistanceprograms are difficult to understand. Indigent persons are often hindered from receiving requiredmedical care because of transportation problems. Health care professionals and institutions are oftenreluctant to accept payment- from Medicaid and Medicare because of the slowness of the system andthe costs associated with preparing paperwork to request payment from these programs. In somecases, the manner in which services are provitJed to indigent persons influence them to amid them.The study recommends decentralizing some of University Hospital's services by developing primaryhealth care clinics at several of the existing public health clinic sites in Jacksonville. Such clinicsshould be staffed by personnel from University Hospital, the Public Health Division and other medicalpersonnel from the community.
Jacksonville lacks a coordinated health planning mechanism for the medically indigent. UniversityHospital, Public Health and Visiting Nurse Association each receive city funds for provision of certainhea Ith ca re se rvices to the ind igent, but these agenc ies do not engage in fo rma I coope rat ive plann ing.The study recommends that such a formal cooperative relationship be established between these agen-cies to plan for continuity of indigent care. In addition, the study recommends that city governmentdesignate a mechanism through which it can receive recommendations regarding the provision of healthcare to the indigent in Jacksonville.
National economic forces, such as inflation, influence the local delivery of health care. The publichas increasingly demanded high quality health care. Government has assumed some responsibility forprovision of medical care to the indigentuprimarily through MediCaid and Medicare--but theseprograms cover only part of the costs of such care. Health care subsidies (cost-shifting) are con-cealed in hospital, physician and insurance bills of other (paying) patients in order to allow healthcare providers to net sufficient income for operation. Enhanced funding of Florida's Medicaidprogram is important. Increasing concern about medical malpractice claims has resulted in physiciansoften ordering unnecessary medical tests to protect themselves in case of suit. Such practices result
-"'-.-/ in higher health care costs for everyone. The study reconmends state legislation to reduce thefinancial malpractice risk of health care personnel who might otherwise donate services to the indi-gent.
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In addition, the JCCI study recommends:
"-' A referral service operated by the Dwal County Medical Society to provide information aboutphysicians and hospitals which will treat and accept indigent patients and/or accept Medicaid.
Donation of services by health professionals as a way to fulfill educational loan obligations.
Requiring local hospitals which benefit from city revenue bonds to provide certain levels offree or reduced cost care to the indigent.
INTR OD UC TI 0 N
This study seeks to determine how Jacksonville, with finite financial resources, can best meet thehealth care needs of its medically indigent populat ion. It proposes ways to improve the planning andcoordination of health services provided to Jacksonville's medically indigent population and to maximizethe impact of federal, state and local funds used to finance such care.
For this study, medically indigent persons were those who met one or both of the followi'ng criteria:
. Financial - Persons without their own funds or access to third party payment (private insurance,Medicaid, Medicare, etc.) for even primary health care.
. Access- Persons who have payment sources (particularly Medicaid) which are unacceptable to someproviders or who experience barriers (such as lack of transportation, poor education, etc.) whichmake receiving health care services or following directions given by health care providers difficult
' / or imposs ible.
The scope of this study includes a review and analysis of:
r. Need for medical services by Jacksonville's indigent population
. Health care resources in Jacksonville" particularly those providing care to the indigent
. Barriers preventing the medically indigent from receiving needed health care
. Health care costs
. Governmental and oth~r financial progra",!s providing payment for medical care for the indigent
. Alternative health care delivery systems
Active and retired military personnel, as well as health care resources available through the area'sNavy bases and the Veterans Administration were excluded from this study. The study also excludedmental health services, dental care and health care provided through specialty hospitals and clinics{rehabilitation, psychiatric, cystic fibrosis, etc. )The study convnittee also did not review situationsin which expenses related to catastrophic illness exhaust personal resources or insurance benefits,
- since the potential for such an occurrence is almost universal.
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