1983 Study: Indigent Health Care by JCCI

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A Report to the

EXECUTIVE

study

Citizens of Jacksonville.

Fall 1983

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 guidelines. 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 downturns 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 agencies 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 concealed 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 indigent.

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In addition, the JCCI study recommends: "-'

A referral service operated by the Dwal County Medical Society to provide information about physicians 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 free or reduced cost care to the indigent.

revenue bonds to provide certain

levels of

INTR OD UC TI 0 N This study seeks to determine how Jacksonville, with finite financial resources, can best meet the health care needs of its medically indigent populat ion. It proposes ways to improve the planning and coordination of health services provided to Jacksonville's medically indigent population and to maximize the 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:

. Medicaid, Financial - Persons without their own funds or access to Medicare, etc.) for even primary health care. . Access'

Persons who have payment

sources

(particularly

third party payment (private insurance,

Medicaid)

which are unacceptable

to some

providers or who experience barriers (such as lack of transportation, poor education, etc.) which make 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:

. Need for medical services by Jacksonville's indigent population . Health care resources in Jacksonville" particularly those providing care . Barriers preventing the medically indigent from receiving needed health . Health care costs r

. Governmental . Alternative

to the indigent

care

and oth~r financial progra",!s providing payment for medical care for the indigent

health care delivery systems

Active and retired military personnel, as well as health care resources available through the area's Navy bases and the Veterans Administration were excluded from this study. The study also excluded mental 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 situations in which expenses related to catastrophic illness exhaust personal resources or insurance benefits, - since the potential for such an occurrence is almost universal.