The RAND Hospital Study That was DOA
NOTE: This begins an on-going series of in-depth articles detailing tax-funded local health care in Broward County. All data will be sourced, and/or supported by information I obtained as a retired Pulitzer Prize-winning.investigative journalist during the past ten years. While I do not post anonymous comments, thoughtful readers may contact me at degrootj@bellsouth.net
Broward County is home to two of the ten largest tax-funded health care systems in the nation:
The North Broward Hospital District (dba as Broward Health) which serves some 1,1 million residents in 21 communities north of the Dania cutoff canal.
The South Broward Hospital District (dba as Memorial Healthcare) which serves some 600,000 residents in ten communities south of the canal.
As quasi governmental entities created by the Florida legislature more than 55 years ago (1) , the two giant healthcare systems are governed by seven-member boards of Commissioners appointed by Florida's governor.
In both their operating cultures, transparency and market areas, the two systems differ dramatically.
For example:
Memorial Healthcare's web page (www.mhs.net) provides both a detailed annual report plus a 67-page audited financial statement prepared by its independent auditors Ernest & Young.
While Broward Health (www.browardhealth.org) provides neither – offering instead a superficial four-page “Financial Report” created especially for its web page.
Memorial Healthcare operates from a growing position of strength thanks to the total patient care monopoly it enjoys in its South Broward market area.
While Broward Health is engaged in an on-going battle for patient care business with seven* competing private hospitals in its service area. (*Cleveland Clinic, Florida Medical Center, Holy Cross, Northwest Medical, Plantation General, University Hospital and Westside Regional.)
That said, Broward's two tax-funded mega-systems are unique among Florida's 67 counties.
Combined, the two Broward health care districts received some $229 million in ad valoreum tax revenue during the last fiscal year (2009) – some $85 million for the South District and $187 for the North.
In Miami-Dade, Jackson Health netted some $178 million in ad volrem taxes during its last fiscal year – plus an additional $187 million from a 1/2-cent county sales tax..
While the Palm Beach Health Care District received $154 million in property tax revenue.
SE Florida's three urban counties feature markedly different approaches to providing tax funded support for indigent patient care:
Broward two hospital districts, for example, operate nine acute care hospitals – plus various clinics and community-based programs.
In Miami Dade, Jackson Health operates three hospitals – plus a wide range of clinics and community based programs.
While the Palm Beach Health Care District supports one hospital in the county's western agri-ghetto – while reimbursing the county's 10 private hospitals for each indigent patient failing to qualify for Medicaid.
Of interest:
Earlier in the current decade, researchers from RAND conducted a study of SE Florida's three tax-funded systems for indigent health care.
Funded by the South Florida Hospital and Healthcare Association, the study found:
The Palm Beach District was easily the most efficient and accountable.
Broward's two mega-systems ranked a clear second in accountability and efficiency.
While Miami-Dade's Jackson Health system was a distant third as a transparent and efficient indigent health care delivery system.
In short, Palm Beach local tax dollars for the uninsured “follow the patient.”
While in Broward and Miami-Dade, 10 government operated hospitals receive all local tax dollars for uninsured patients.
Also of interest:
The RAND report was especially critical of the North Broward Hospital District for the dramatic disparity between the system's gross patient care charges* versus its patient care operating costs – an inequity that continues today where the “mark up over cost” stands at an all-time high (76.5%). (*Uninsured patients are legally responsible for their gross health care charges which are increasingly higher than the cost of their care.)
Of interest...
Recent data indicate the South Broward Hospital District's gross patient care charges have risen much faster than patient care costs.
All of which has led to increased hardship for uninsured patients facing bills with the gross charges for their care.
For example, the following is a ten year comparison of Broward's two tax-funded hospital systems based on the latest available data from Florida's Agency for Health Care Administration:
Gross Patient Charges Vs. Costs
Per Adjusted Admission
Hospital District 1998 2008 % CPI - 32%
North Broward 4 hospitals 4 hospitals
Adjusted Admits 70,752 98,924 40%
Profit $474 $1,119 136%
Patient Care:
Gross Charges $20,563 $33,266 62%
Cost $5,465 $7,808 43%
Mark Up 73.5% 76.5%
South Broward 3 hospitals 5 hospitals
Adjusted Admits 64,645 135,379 109%
Profit ($75) $407 636%
Patient Care:
Gross Charges $14,827 $31,625 113%
Cost $5,339 $8,367 57%
Mark Up 64.0% 73.5%
In the end, the detailed RAND report was never made available to the public – basically due to pressure from Broward's two tax supported hospital districts.
However, this author has a final draft of the controversial 120 page unpublished report that cast a critical eye on the dyanmics of tax-funded healthcare for SE Florida's indigent residents.
NEXT - Further idetails from the supressed RAND on SE Florida's tax-funded indigent health care.
Broward County is home to two of the ten largest tax-funded health care systems in the nation:
The North Broward Hospital District (dba as Broward Health) which serves some 1,1 million residents in 21 communities north of the Dania cutoff canal.
The South Broward Hospital District (dba as Memorial Healthcare) which serves some 600,000 residents in ten communities south of the canal.
As quasi governmental entities created by the Florida legislature more than 55 years ago (1) , the two giant healthcare systems are governed by seven-member boards of Commissioners appointed by Florida's governor.
In both their operating cultures, transparency and market areas, the two systems differ dramatically.
For example:
Memorial Healthcare's web page (www.mhs.net) provides both a detailed annual report plus a 67-page audited financial statement prepared by its independent auditors Ernest & Young.
While Broward Health (www.browardhealth.org) provides neither – offering instead a superficial four-page “Financial Report” created especially for its web page.
Memorial Healthcare operates from a growing position of strength thanks to the total patient care monopoly it enjoys in its South Broward market area.
While Broward Health is engaged in an on-going battle for patient care business with seven* competing private hospitals in its service area. (*Cleveland Clinic, Florida Medical Center, Holy Cross, Northwest Medical, Plantation General, University Hospital and Westside Regional.)
That said, Broward's two tax-funded mega-systems are unique among Florida's 67 counties.
Combined, the two Broward health care districts received some $229 million in ad valoreum tax revenue during the last fiscal year (2009) – some $85 million for the South District and $187 for the North.
In Miami-Dade, Jackson Health netted some $178 million in ad volrem taxes during its last fiscal year – plus an additional $187 million from a 1/2-cent county sales tax..
While the Palm Beach Health Care District received $154 million in property tax revenue.
SE Florida's three urban counties feature markedly different approaches to providing tax funded support for indigent patient care:
Broward two hospital districts, for example, operate nine acute care hospitals – plus various clinics and community-based programs.
In Miami Dade, Jackson Health operates three hospitals – plus a wide range of clinics and community based programs.
While the Palm Beach Health Care District supports one hospital in the county's western agri-ghetto – while reimbursing the county's 10 private hospitals for each indigent patient failing to qualify for Medicaid.
Of interest:
Earlier in the current decade, researchers from RAND conducted a study of SE Florida's three tax-funded systems for indigent health care.
Funded by the South Florida Hospital and Healthcare Association, the study found:
The Palm Beach District was easily the most efficient and accountable.
Broward's two mega-systems ranked a clear second in accountability and efficiency.
While Miami-Dade's Jackson Health system was a distant third as a transparent and efficient indigent health care delivery system.
In short, Palm Beach local tax dollars for the uninsured “follow the patient.”
While in Broward and Miami-Dade, 10 government operated hospitals receive all local tax dollars for uninsured patients.
Also of interest:
The RAND report was especially critical of the North Broward Hospital District for the dramatic disparity between the system's gross patient care charges* versus its patient care operating costs – an inequity that continues today where the “mark up over cost” stands at an all-time high (76.5%). (*Uninsured patients are legally responsible for their gross health care charges which are increasingly higher than the cost of their care.)
Of interest...
Recent data indicate the South Broward Hospital District's gross patient care charges have risen much faster than patient care costs.
All of which has led to increased hardship for uninsured patients facing bills with the gross charges for their care.
For example, the following is a ten year comparison of Broward's two tax-funded hospital systems based on the latest available data from Florida's Agency for Health Care Administration:
Gross Patient Charges Vs. Costs
Per Adjusted Admission
Hospital District 1998 2008 % CPI - 32%
North Broward 4 hospitals 4 hospitals
Adjusted Admits 70,752 98,924 40%
Profit $474 $1,119 136%
Patient Care:
Gross Charges $20,563 $33,266 62%
Cost $5,465 $7,808 43%
Mark Up 73.5% 76.5%
South Broward 3 hospitals 5 hospitals
Adjusted Admits 64,645 135,379 109%
Profit ($75) $407 636%
Patient Care:
Gross Charges $14,827 $31,625 113%
Cost $5,339 $8,367 57%
Mark Up 64.0% 73.5%
In the end, the detailed RAND report was never made available to the public – basically due to pressure from Broward's two tax supported hospital districts.
However, this author has a final draft of the controversial 120 page unpublished report that cast a critical eye on the dyanmics of tax-funded healthcare for SE Florida's indigent residents.
NEXT - Further idetails from the supressed RAND on SE Florida's tax-funded indigent health care.
(1) NOTE - Broward's two tax-funded public health care systems were created as separate taxing districts by local politicians and community leaders back in the mid-1950's largely due to bigotry. Like:
--- South Broward (Hollywood) was a welcome home to a large number of Jewish residents.
--- While North Broward (Fort Lauderdale) was highly anti-semitic and home to very few Jewish residents.
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