A way forward on improving Manatee's health

May 6, 2014 

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Ambulances pack the emergency room parking area at Manatee Memorial Hospital. Health care executive Kevin DiLallo has suggested making another effort to pass a surtax to pay for health care for the poor in Manatee County.GRANT JEFFERIES/Bradenton Herald

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Today Manatee County commissioners will consider authorizing a study designed to determine both the community's health care needs and a strategy to address those. County administrators are proposing a yearlong research project to address improving the quality of health for all, especially the indigent and working poor.

Manatee County can ill afford to let this issue slide in the wake of the 2013 voter defeat of a surtax that would have replaced the indigent health care fund, which will empty out next year.

That trust fund reimburses private medical providers for some -- but not all -- of the expenses of health care for the poor.

The county proposes contracting with a team from the University of South Florida College of Public Health. The research would be paid out of trust fund money in the amount of $196,000, funneled through the Manatee Chamber Foundation.

A primary criticism of last summer's half-cent sales tax vote focused on the lack of a concrete plan for spending the money. The county intends to address that failure by coming up with a detailed strategy that identifies the most cost-effective and outcome-maximizing solution.

The overall goal is to drive down costs, mostly by stemming inappropriate use of expensive hospital emergency room care for minor conditions. The study issues include primary, preventative and hospital care, case management of the medically poor and more -- all to create innovative programs that contain costs.

State law allow counties to levy a half-cent sale tax dedicated to indigent care. Hillsborough County stands out as model of innovation, as we opined in April.

That county's half-cent sales tax pays for a comprehensive managed-care program for residents with limited income and assets who do not qualify for other health care coverage, including Medicare and Medicaid. Hillsborough HealthCare contains strict enrollment eligibility requirements, and members have co-payments for certain services, including prescriptions.

Manatee County has been grappling with the health care issue for years now, once culminating in the 2008 USF student "State of Health Care System in Manatee County." This community recognizes that medical care is critical to economic health.

This new study, should commissioners move forward, would seek input from community leaders of all types, stakeholders and citizens, not just within the health system. Researchers would inventory community resources important to achieving the goal, and then create a plan for moving forward.

Some topics that plan should address include effective chronic disease management, access to care, prevention and wellness.

One of the keys is reducing indigent reliance on emergency rooms. Part of that focuses on teaching patient accountability and healthy behaviors.

All of this wraps into a vital public policy objective. We need a well-designed and focused health care plan for the future. That would quell the objections of some opponents to last year's failed referendum.

Manatee County's health care trust fund, created in 1984 with the $44.3 million sale of then publicly owned Manatee Memorial Hospital, will be depleted next year. Even now, county property tax revenue helps with medical care reimbursement.

Opposition to the study has surfaced, labeling the entire idea of tax expenditures on indigent health care as "corporate welfare" that pads profits.

Doctors and hospitals already write off significant amounts of time, energy and resources to help the medically needy. Should society expect physicians to work for free and hospitals to absorb all those costs?

We think not. Communities around the nation share in that obligation. Manatee County wants to find the best way to accomplish that with the best medical outcomes and the least expense. That's a worthy goal.

Commissioners should forge ahead to secure solid research and a strategic plan.

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