November 23, 1999 Community Columnist Article

Tim Lynch, Ph.D.
Director
Center for Economic Forecasting and Analysis
Florida State University
850.644.7357
 

A Sound Economic Investment in Primary Care Health Services for the Leon County Uninsured Children and Adults We can Live With
 

Recently, through the pages of the Democrat, we all vicariously shared the painful story of an indigent man whose assailant shot him in the head and left him to die on the cold streets of Tallahassee. Even though the heroics of the TMH doctors and nurses saved his life his circumstance all to soon darkened. Just 36 hours after his operation he was discharged back to the Tallahassee streets and a world of inadequate primary health care, shelter and resources to help him return to full health.

Who is to blame for the lack of adequate primary health care available to the uninsured in Tallahassee? The hospitals, doctors, patients themselves, we the community? The Democrat in its November 7 editorial concludes that there's plenty of blame to go around. I believe if we as a community are responsible for the inadequate primary health care available to the uninsured in our All America City, then we are all also responsible to fix this problem.

Since 1995, the Leon County Health Department has received a static $398,000 per year in state funds to provide primary care services to non-Medicaid Leon County citizens. That is a woefully inadequate $8.66 per year for primary health care for each uninsured resident. This level of funding only allows the Department to treat 1,393 patients this year. Meanwhile, even in the midst of our regions longest economic expansion, the number of uninsured continues to grow. Today an estimated 46,000 Tallahassee men, women and children have no health insurance coverage even though 85% of the uninsured adults are gainfully employed.

Those not getting treatment at the County Health Department turn to our hospitals' emergency rooms for primary care. Unpaid charity and bad debt charges have doubled at TMH since 1990 to $32 million in 1998 and tripled at TCH to $7.7 million last year. Much of this cost is for delivery of primary care services through expensive emergency room doors that should be delivered at public health clinics at a third of the cost. (Article continued below)

Somebody has to pay for these uncollected debts and typically cost shifting to paying patients is the only choice the hospitals have. These unpaid bills increase the cost of a hospital stay for those of us with health insurance by an average of almost $200 per day at local hospitals.

With 42% of all Tallahasseeans covered by cost-cutting HMOs, local hospital cost shifting options are very limited. This is especially true since HPSE and CHP experienced losses of $125 and $86 per enrollee respectively in 1998. These HMO losses resulted in drops in average HMO hospital payments locally and stripped the hospitals of an important source of profits to help subsidize these substantial charity care burdens. These increases in private patient care costs, in turn, help drive the upward spiral in our insurance rates every year. For example HealthPlan Southeast and Capital Health Plan were authorized premium increases of 15 and 17 percent respectively this year while also almost doubling their medication co-payment fees.

One possible solution to this crisis in availability of primary care for the uninsured worthy of support was put forth by the Leon County/Tallahassee Health Care Advisory Council on November 23, 1999. The Council proposes to expand primary care clinic services by $2.7 million, pharmacy and lab services by $750,000, specialty care by $350,000 and coverage for kids through the Healthy Kids program by $286,000 annually. These expansions in health care services will be funded by a modest local property or sales tax increase.

Services will be free to those with incomes under the poverty level and on an affordable sliding scale based on family income thereafter. This much-needed economical expansion of services can result in substantial savings for each of our hospitals since the extensions build on existing programs. These proposals are also of vital importance to improve the basic health and quality of life of those uninsured children and adults in our community.

The impact of these savings can be enormous with a potential benefit-to-cost- ratio of 8 or greater. For example if this initiative resulted in saving just half of the current charity losses experienced by both of Tallahassee's hospitals, the $19.9 million savings would generate an additional $34 million in new Leon county economic activity. These activities would generate 638 new full-time jobs and $17 million in new income across all areas of employment in the Tallahassee economy.

These are investments and returns we can live with.
 

Dr. Tim Lynch is Director of the Center for Economic Forecasting and Analysis at Florida State University and can be reached at lynch@cefa.fsu.edu