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We need more doctors, not hospitals

Florida's full-service hospitals are facing huge cuts in federal and state funding to care for the elderly, poor and uninsured. They're grappling with serious shortages of physician specialists and other health care workers.

Now, along with these profound challenges, there is a proposal in the Florida Legislature to eliminate the state's planning process for new hospitals. Full-service hospitals are united in their opposition to this proposal because it will further destabilize Florida's health care landscape.

Eliminating health planning for new hospitals will lead to the explosion of small "limited service" hospitals and a two-tiered hospital system in Florida: one for the poor and uninsured, and another for healthier patients with private insurance.

Florida doesn't need more hospitals. What Floridians need are more doctors (particularly specialists), more nurses, more health care workers and fewer uninsured citizens.

Florida is one of 36 states that see the value in retaining a planning process for new hospitals, and our process is working. It promotes orderly, highly competitive growth of new full-service hospitals, and assures that all patients — regardless of income — have access to vital health care services.

Since 1999, 28 acute care hospitals have been authorized under Florida's health planning process. Since 2004, when the Legislature eased the approval process for new beds at existing full-service hospitals, 4,300 beds have been added or are coming online.

What can Florida expect if the Legislature eliminates the planning process for new hospitals? One need only look to rapidly growing states like Texas and Arizona, which ended planning for new, full-service hospitals and have seen a surge of limited-service hospitals.

Limited-service hospitals are typically 20- or 30-bed facilities that thrive by providing profitable services to healthier patients with private insurance. These hospitals provide limited or no emergency services and offer very little or no care to charity, uninsured or Medicaid patients — most of whom gain access to hospital care through the emergency room.

This creates a two-tiered system in which full-service hospitals must carry the burden for providing emergency services, caring for the poor and uninsured, and offering the unprofitable yet vital health services such as trauma, burn and neonatal care.

Additionally, limited-service hospitals actually increase health care costs while eroding patient safety, studies have shown.

Eliminating planning and allowing a free-for-all of limited service hospitals isn't creating real competition that benefits Floridians. Instead, it's creating an unfair playing field that will hamper the mission and the financial health of Florida's full-service hospitals.

Any serious discussion of allowing a proliferation of new limited-service hospitals must include answers to this question: Where will all the doctors, specialists and nurses come from?

Florida hospitals are already experiencing staffing shortages. Today, 16 full-service hospitals have exemptions from a state requirement that they provide certain emergency services 24/7 because there simply aren't enough physician specialists for round-the-clock coverage.

If Florida's existing full-service hospitals must compete with new limited-service hospitals for physician specialists and nurses, the state's health care staffing shortages will only worsen while labor costs rise.

Florida leads the nation in percentage of residents over 65 and 85; one in four residents under 65 is uninsured; and huge cuts in Medicaid and Medicare reimbursements are looming. Against this backdrop, legislators must avoid taking unwise actions that further destabilize health care. Now simply isn't the time to consider eliminating the state's planning process for new hospitals.

Wayne NeSmith is the president of the Florida Hospital Association. Tony Carvalho is the president of the Safety Net Hospital Alliance of Florida.

We need more doctors, not hospitals 03/23/08 [Last modified: Thursday, March 27, 2008 8:51am]
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