Jackson Memorial Hospital is a vital and unique teaching hospital that serves the critical community obligation of caring for all, regardless of ability to pay.
Jackson is the nation’s largest public hospital. It is also one of the best, with national recognition awarded every year for various areas of care. The University of Miami School of Medicine’s world-renowned doctors, nurses and professors are a major component of Jackson’s excellence. Now, Florida International University’s academic medical expertise is an additional benefit.
For a variety of reasons, though, this hospital is in a critical-care crisis of its own that threatens its fundamental mission. Unfortunately, it is a crisis that nearly all public hospitals in America face or have faced in recent years, brought on by underfunding, high operational costs and increased service demands from uninsured patients.
Jackson has seen a steep rise in county unfunded mandates for inmate and long-term nursing care and about $250 million in charity care that is also not covered by county tax dollars. Ultimately, through this revenue imbalance, Jackson’s facilities will become outdated, equipment obsolete and services compromised.
The trend, nationally, has been to take these public institutions out of politics and turn them into one of two business models: a special taxing district that allows for dedicated hospital revenues; or, a private charity model that essentially commits to providing care for all but operates like a private hospital business. The private model has become the choice, especially when academic teaching hospitals are considered.
Tampa General Hospital, Grady Health System in Atlanta, the former New York Hospital system — now a five-hospital system — are all examples of public institutions having changed their business model. Most health-care analysts believe the private organization delivers health care far less expensively and much more efficiently. In the recent past, more than a quarter of all U.S. public hospitals have switched to a private business model and have still maintained public care missions.
Locally, the North Broward Hospital District Board of Commissioners is studying the possibility of allowing a private non-profit 501(c) 3 organization to run the North Broward District.
Currently, 23 other hospital systems in Florida have made the move from public organizations to private entities. The Miami-Dade County Board of County Commissioners, on the other hand, passed a resolution on Nov. 16 forbidding the Public Health Trust, the quasi government entity that runs the Jackson Health System, from even considering any alternative governance for Jackson.
Given the existing circumstances, what is the likely future of the Jackson Health System and its mission of caring for all Miami-Dade residents, regardless of ability to pay?
Unemployment is likely to continue at historically high levels, sending more residents without insurance to Jackson. The county is unlikely to increase its taxes and, therefore, won’t raise tax contributions to Jackson. The county government continues to demand services from Jackson without providing additional funding to pay for them. As a result, the most probable near-term future is continued deterioration of the hospital’s buildings and equipment and perhaps reduction in medical services and care or even de facto rationing of care.
What can be done to end this critical care crisis? First, as recommended in the Aug. 5, Grand Jury report, the county must fund all services it imposes on the health system.
Next, a community leadership task force must be formed to determine the business model that will allow the hospital to survive and thrive. Finally, the new business model must be implemented. If Tampa, Atlanta, New York, Houston, and Broward County can find solutions, why must Miami-Dade live without one?
The time for radical change is now. Jackson’s failure is not an option.
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