Accessing adequate health care poses a major concern for millions across the United States who fall below 100 percent of the federal poverty line but do not qualify for public programs such as Medicaid and SSI. For years, the uninsured in Florida's Hillsborough County depended heavily on the services of Tampa General Hospital, the county's only public hospital. However, the costs of treating these uninsured patients were often written off as uncompensated care, which forced physicians to compensate by increasing charges for private paying patients or appealing for increased tax support. In the early 1990s, Hillsborough County faced a financial burden as the cost of care for the uninsured was increasing at a rate of about $6 million annually. The county's worries were compounded by the serious financial difficulties of Tampa General Hospital, and a recent proposal to privatize the facility had provoked widespread community apprehension and opposition.
As a result, the Hillsborough County Commission joined with local civic and business organizations to petition the Florida Legislature for permission to levy a limited local-option sales tax to fund a new approach to financing health care. In 1991, the legislature agreed to the proposal, expanding a broad range of health and social services to thousands of county residents. Under the plan, a half-cent sales tax increase would pay for health-care services for poor and uninsured county residents.
Four regional managed-care networks were created to provide primary and preventive care for the uninsured, reducing the need for costly hospital inpatient and emergency room care. Since 1993, ten additional managed care networks have been created. To identify appropriate providers for each network, the county requests bids from groups of physicians, hospitals, and clinics willing to serve participating patients at reduced rates. The networks must meet certain additional criteria, such as short waiting time for non-urgent visits and proximity to public transportation. To encourage competition among the providers, participants can choose from any of the networks and are permitted to switch providers at any time. Within each network, participants pick a primary care doctor, whom they are supposed to visit before going to a specialist or to the emergency room.
Additionally, mental health, dental, and other ancillary services are available through contracts with a number of public and private providers. To ensure that the services are easily accessible, a voucher system for transportation to the health care facilities is offered, and clinics are open evening and weekend hours for working patients. Participating patients only have to cover small co-payments and are not responsible for premiums, as the county's new sales tax and property taxes adequately cover the financial demands.
The integrated system of social services and medical case management has successfully kept patients active in the plan, getting them into clinics or specialty services and out of hospitals. Of the county's 39,000 eligible residents, an estimated 24,000 utilize the program's services, significantly reducing the strains placed on the county and improving the overall health of its residents. In 1992, inpatient hospital services accounted for 60 percent of the county's indigent health care budget, but by 1994, this figure had decreased to only 32 percent. In addition, emergency-room use decreased by 27 percent. These drops are directly correlated to the increased funding for clinics, which rose from one to 12 percent of the county's indigent health care budget, providing patients with the proper primary and preventative care necessary for a healthy life.