Organization and Financing of Indigent Hospital Care in South Florida

Over 700,000 uninsured persons living in south Florida depend upon county government to provide hospital care. The three counties in south Florida — Broward, Miami-Dade and Palm Beach — vary in their demographics, the composition of the hospital markets, and approach to financing and providing care for the uninsured. The South Florida Hospital and Healthcare Association commissioned this study to compare the approaches and assess whether or not one approach is better than the other. Broward uses ad vallorum property taxes to fund a network of public hospitals and clinics, Palm Beach levies an ad vallorum tax to support a public managed health insurance program, and Miami-Dade subsidizes public hospital care at two public hospitals through a combination of property tax revenues and a dedicated half-penny surtax for the major public hospital, Jackson Memorial. While it was not possible to determine the “best” overall system because the counties varied so greatly, we found that in Broward and Miami-Dade counties only publicly owned hospitals received local public funds to provide care for the indigent; all other hospitals provided care to the uninsured without compensation. Palm Beach, however, reimbursed all hospitals for care provided to those enrolled in the public health care program. Comparisons between patient travel patterns for those insured and uninsured showed greater variation within than between counties. In all counties, the uninsured had a higher percentage of admissions for emergency conditions than those with insurance.