Governance for Whom and for What

This study examines the governance of public funds for health care, focusing on Miami-Dade County, Florida. It discusses principles of good governance, synthesized from a literature search and summarizes the governance approaches used by others for the delivery of health care services. This report describes the current governance structure in Miami-Dade implemented through the Miami-Dade County Public Health Trust (PHT) and provides a series of recommendations for structural reform. The PHT currently operates the county-owned health care facilities and is also responsible for countywide planning to ensure access to health care for all residents. This dual mission -- service provision and policy development and implementation -- inherently creates a conflict of interest. Moreover, the level of accountability of the PHT to the Board of County Commissioners and the public has eroded over time, reducing public trust. Using the principles of good governance, along with the lessons learned from other locales, the report recommends that the provision of services and countywide health care planning be separated, making these functions the responsibility of two independent agencies. It also recommends that funding be provided to implement new, innovative approaches to providing health care services to the indigent.