Armado de Estructura

A listing of health insurance coverage by major providers for Region IV residents can be found in Table 71. These figures represent reported enrollments in Medicare, Medicare HMO,

Medicaid, Medicaid HMO, and Commercial HMO insurance programs. Significant numbers of insured residents are not reported because commercial insurance enrollment figures are not available and the number of employees covered by self-insured employers is unknown. For more detailed information regarding which commercial HMOs the region’s residents are enrolled in, refer to Appendix Table E-2.

Table 71

Health Insurance Coverage, 2002

Percent of Population by Type of Health Care Coverage

* Medicare Medicare

HMO Medicaid Medicaid HMO Commercial HMO

Area Population Enrollment % Enrollment % Enrollment % Enrollment % Enrollment %

Baker 22,724 2,608 11.5 289 1.3 3,401 15.0 876 3.9 6,332 27.9 Clay 144,598 16,037 11.1 1,978 1.4 8,043 5.6 2,299 1.6 30,484 21.1 Duval 802,952 95,449 11.9 17,878 2.2 101,966 12.7 32,222 4.0 239,999 29.9 Flagler 55,042 15,037 27.3 4,382 8.0 3,405 6.2 0 0 12,303 22.4 Nassau 60,504 8,535 14.1 8 0.01 3,882 6.4 0 0 12,345 20.4 St Johns 131,879 21,539 16.3 46 0.03 8,820 6.7 0 0 15,677 11.9 Volusia 457,852 102,135 22.3 34,008 7.4 54,412 11.9 14,592 3.2 129,795 28.3 Region IV 1,675,551 261,340 15.6 58,589 3.5 183,929 11.0 49,989 3.0 446,935 26.7 Source: Department of Insurance Quarterly HMO Enrollment Reports and AHCA Monthly Medicaid

Enrollment Reports, as of June 30, 2002

* Medicare Enrollment, Centers for Medicare & Medicaid Services (CMS), as of July 1, 2001 AHCA Population Projections, January 1, 2002

The large proportion of Medicare coverage in Flagler and Volusia Counties is indicative of the sizeable elderly populations residing in those counties. The greatest proportions of

The majority of working people receive their health care coverage through their employer. In November and December of 2002, nearly 4,000 employers responded to the Florida Chamber Federation’s statewide health insurance survey. Results revealed that 76% of Florida employers surveyed currently offered health insurance to their employees, down from 77% in 2001 and 91% in 1999. Approximately 86% of the employers reported experiencing an increase in premiums, and of those, 47% received greater than 20% increases. Forty-two percent of the employers surveyed indicated that they would be forced to consider eliminating health insurance benefits if they experience additional increases in premiums. This issue continues to be an ongoing concern for many Floridians who depend on employer-based coverage for their health insurance.

Medicaid Eligibles

The number of Medicaid eligible clients in Region IV increased 47% between 1998 and 2002 (Table 72). The greatest increase occurred in Duval County, where the number of eligible persons increased by 34,809, or nearly 52%.

Table 72

Medicaid Eligibles, 1998-2002

Number of Medicaid Eligibles as of 7/31

Area 1998 1999 2000 2001 2002 1998-2002 % Change Baker 2,352 2,472 2,951 3,171 3,410 45.0 Clay 5,752 6,196 7,111 7,917 8,078 40.4 Duval 67,417 71,508 83,961 93,373 102,226 51.6 Flagler 2,424 2,696 2,915 3,137 3,431 41.5 Nassau 3,186 3,184 3,805 3,772 3,830 20.2 St. Johns 6,509 6,724 7,668 8,483 8,829 35.6 Volusia 37,542 41,773 47,357 50,921 54,598 45.4 Region IV 125,182 134,553 155,768 170,774 184,402 47.3

Source: Agency for Healthcare Administration, 2002

Florida KidCare

Federal government provisions for children’s health coverage include Medicaid and Title XXI of the Social Security Act. The states use Title XXI block grants to fund child health care coverage through an expansion of the Medicaid program, health insurance, or a combination of the two. In Florida, the KidCare Act of 1997 expanded Medicaid eligibility and the Healthy Kids Program, and initiated the MediKids program for children ages 0-4.

The Balanced Budget Act that established the State Children’s Health Insurance Program (SCHIP) in 1997 included a 26% reduction in federal funding for the years 2002 through 2004, to ensure a balanced budget in 2002. The number of children insured through SCHIP, known as Florida KidCare, will eventually fall unless the funding is increased. Based on projections, Florida will begin to feel the effects of this funding dip in 2003, when the level of federal SCHIP expenditures Florida needs to sustain its projected KidCare enrollment will exceed the total federal SCHIP funds available. If Florida is unable to increase state funding to compensate, there will be no choice but to cut KidCare Programs.

Currently, there are an estimated 350,000 uninsured children in Florida who are eligible for Florida KidCare and who lack private health insurance. Florida is the only state that requires counties to provide local matching funds to support the Healthy Kids portion of the KidCare health insurance program. This local match has been a significant barrier for thousands of eligible children who reside in counties with limited financial resources.

Region IV’s KidCare Program enrollment figures are provided in Table 73. The highest enrollment for the Healthy Kids Program in the region is seen in Volusia County, followed by Duval. The Healthy Kids Program became available in Baker, Clay, Nassau, and St. John’s Counties in 2000.

Table 73

KidCare Enrollment, 2002

KidCare Program Enrollment ^

Area Healthy Kids Medical ServicesChildren’s MediKids Medicaid Enrollment Total

Baker 277 7 36 1,927 2,247 Clay 1,617 52 220 4,708 6,597 Duval 8,763 206 1,054 60,041 70,064 Flagler 1,151 20 102 1,890 3,163 Nassau 688 21 90 2,058 2,857 St. Johns 910 24 110 4,144 5,188 Volusia 9,517 181 813 31,199 41,710 Region IV 22,923 511 2,425 105,967 131,826 Florida 269,536 8,215 33,217 1,134,197 1,445,165

Note: ^ Healthy Kids and Children’s Medical Services enrollment as of January 1, 2003; MediKids and Medicaid enrollment as of December 31, 2002. Healthy Kids numbers include enrollees covered under both Title XXI funds and other health insurance options

Source: Florida KidCare Enrollment Report, December 2002/January 2003

HOSPITALS

Hospitals represent the largest single cost within the health care delivery system. Corporate mergers, takeovers, facility conversions and closures are among the economic survival strategies employed by regional hospitals. In 1990, 23 community hospitals operated in Region IV. In 2000, a decade later, that number decreased to 17.

Table 74 presents hospital net revenue and expenses on a per patient day basis for years 1995 and 2000. Hospital net revenue and expenses varied considerably among the region’s hospitals. The greatest increase in per patient per day revenues during this time period was seen at Ed Frasier Memorial Hospital, which also had the highest increase in expenses. Baptist Medical Center-Nassau and Florida Hospital-Oceanside were the only two hospitals in the region to experience a decrease in both net revenue and expenses between 1995 and 2000.

Table 74

Acute Care Hospital Revenues and Expenses, 1995, 2000

$ Per Patient Day

1995 2000 % Change 1995-2000

Area Acute Care Hospital Revenue Net Expenses Revenue Net Expenses Revenue Net Expenses

Baker Ed Frasier Memorial Hospital $692 $676 $3,394 $3,695 390.5 446.6

Clay Orange Park Medical Center $1,049 $920 $1,229 $968 17.2 5.2

Duval Baptist Medical Center $1,124 $1,074 $1,199 $1,183 6.7 10.1

Baptist Medical Center-Beaches $960 $891 $922 $922 -4.0 3.5 Memorial Hospital-Jacksonville $1,296 $997 $1,362 $1,119 5.1 12.2

Shands Jacksonville^ --- --- $1,282 $1,488 N/A N/A

Methodist Medical Center^ $964 $1,036 --- --- N/A N/A University Medical Center^ $1,232 $1,258 --- --- N/A N/A St. Luke’s Hospital $1,671 $1,653 $2,047 $2,036 22.5 23.2 St. Vincent’s Medical Center $1,201 $1,053 $1,224 $1,231 1.9 16.9

Flagler Florida Hospital-Flagler $785 $765 $1,024 $1,000 30.4 30.7

Nassau Baptist Medical Center-Nassau $1,133 $1,050 $1,096 $882 -3.3 -16.0

St Johns Flagler Hospital $934 $860 $1,159 $1,136 24.1 32.1

Bert Fish Medical Center $960 $1,010 $1,103 $1,242 14.9 23.0 Florida Hospital-Fish Memorial $979 $1,196 $1,147 $1,080 17.2 -10.0 Halifax Medical Center $969 $1,089 $1,295 $1,442 33.6 32.4 Florida Hospital-Ormond Memorial $1,214 $1,188 $1,265 $1,327 4.2 11.7 Florida Hospital – Oceanside $861 $847 $748 $817 -13.1 -3.5 Volusia

Florida Hospital-DeLand $849 $926 $910 $1,089 7.2 17.6 Notes: Net Revenue = Net Operating Revenue/Adj Patient Days

Expenses = Salary + Other Expenses/Adj Patient Days All $ rounded to nearest whole dollar

^ Methodist and University Medical Centers merged in 2000 and became Shands Jax Medical Center Source: 1995, 2000 Hospital Financial Data, AHCA

Figure 23 displays the payment source for inpatient hospital services used by Region IV’s

residents in 2001. Public funding continues to pay for the majority of hospital charges incurred in the region’s hospitals. The Medicare program is the largest payer for inpatient hospital services. Traditional Medicare and Medicare HMO programs accounted for 39% of all payments in Region IV’s hospitals. Medicaid and Medicaid HMO programs paid for 16%, less than half of Medicare’s spending level. The balance of other public expenditures for inpatient hospital services was paid by “other” sources, including Workers Compensation, Champus, and other government programs.

The second largest payer group, public, or private, was commercial HMO/PPO providers that covered 29% of inpatient hospital service costs. Relatively small proportions of inpatient hospital service costs are paid by commercial insurers or out-of-pocket consumers.

Payer Source for Hospitalized Region IV Residents, 2001 Medicare 32% Commercial Insurance 6% Other 3% Self Pay/Charity 6% Medicare-HMO 7% Medicaid 11% Commercial HMO/PPO 29% Medicaid-HMO 5% Source: AHCA Hospital Discharge Data, 2001

Medicaid patients are more clustered among area hospitals than are Medicare patients in Region IV. Approximately 45% of Medicaid patients in the region received treatment in 3 hospitals – Baptist Jacksonville, Shands Jacksonville, and Halifax Medical Center in Volusia (Figure 24). Medicare patients are more dispersed throughout the region’s hospitals (Figure 25). St.

Vincent’s Medical Center experienced the largest concentration, treating 11% of the region’s Medicare patients in 2001.

Figure 24

Hospital Utilization by Medicaid Resident, 2001

All Others 17% Memorial-Jacksonville 8% Florida-DeLand 8% Flagler Hospital 6% Orange Park 8% Shands Jacksonville 23% Baptist-Jacksonville 11% St. Vincent's 8% Halifax 11% Source: AHCA Hospital Discharge Data, 2001

Figure 25

Hospital Utilization by Medicare Resident, 2001

Halifax 9% Shands Jacksonville 9% Memorial-Jax 8% St. Luke's 7% Flagler Hospital 8% All Others 15% Orange Park 5% St. Vincent's 11% Florida-DeLand 4%

Florida - Fish Memorial 4% Bert Fish 4% Florida-Ormond Memorial 8% Baptist-Jacksonville 7%

Source: AHCA Hospital Discharge Data, 2001