4052 Bald Cypress Way, Bin C15
Tallahassee, FL 32399-1735
The delivery of healthcare services in rural Florida is similar to that in other areas of the country. In the United States, healthcare services are offered by a variety of medical providers that function as independent businesses in a mixed economy of public, private, for-profit, and not-for-profit government and religious entities. These entities provide services to a rural population with poorer health status, and lower income and educational attainment levels, many of whom are dependent upon government insurance programs to pay for healthcare. In this environment, coordination of healthcare services is dependent upon the provider and occurs largely on a case by case basis. This market based approach to health care creates a number of structural barriers to receiving care and results in a fragmented non-system of health care delivery.
Due to the lack of a system for the delivery of health and medical services, the focal point of healthcare delivery in most rural communities continues to be the rural hospital. Currently, Florida has 29 statutory rural hospitals as defined by paragraph 395.602(2)(e), Florida Statutes. Geographically, the 29 rural hospitals are distributed across 20 rural counties and the rural portion of three urban counties. Ten of Florida's 30 rural counties currently lack an acute care hospital facility. Seven of the rural hospitals are owned and operated by hospital taxing districts, eleven are not for profit entities, ten are for profit entities, and one is a county owned facility. Eleven of the 29 hospitals are part of a larger hospital system. Thirteen of the 29 rural hospitals have converted to Medicare Critical Access Hospital status, the most recent being two rural hospitals in the Florida Keys. In 2011, Florida's 29 rural hospitals admitted 49,268 inpatients, employed 6,134 full time equivalent staff, provided $97.9 million in charity care, and $181.1 million in bad debt. The majority of Florida's rural hospitals continue to struggle financially with 20 of 29 having a negative operating margin with margins ranging from 26.4% to -64.2%. Fourteen rural hospitals had a negative total margin with margins ranging from 23.9% to -64.2%. Two of three rural counties in the Florida Panhandle with rural hospitals that had previously closed in 2005 (Gadsden & Gulf), reopened or replaced these hospitals in 2010.
Rural health clinics and community health centers play important roles in efforts to improve access to health care for poor and uninsured residents. There are currently 146 rural health clinics operating in Florida, 45 of which are located in areas currently considered urban. There are also 50 Federally Qualified Health Centers (FQHC) and two FQHC look alikes providing services at 330 sites that serve 23 rural and 35 urban counties in Florida. Ten of these are affiliated or operated by county health departments, two by rural health networks (Monroe and Collier), and one by a Local Health Planning Council (Big Bend). Thirty-five of the FQHCs also provide dental services at 282 sites. In 2012, FQHCs in Florida served 1.2 million patients.
Florida has county health departments (CHD) in each of its 67 counties that are jointly funded using state and local funds. These CHDs provide a wide range of public and preventive health services to the residents of their respective counties. Ten CHDs are designated as FQHCs.
Florida is fortunate in having relatively sophisticated emergency medical services (EMS) with all 67 counties providing advanced life support (ALS) services staffed by trained and certified paramedics. Florida's counties are required by statute to provide EMS which is supported by local funds with additional state grant funding provided from fines for moving traffic violations. Forty-three government supported EMS providers are currently operating in Florida's 30 rural counties. Rural EMS providers received $1.3 million in state grants for training and equipment in 2011. Rural EMS providers responded to 126,167 EMS calls in 2011 with approximately 70 percent of the patients being transported to a healthcare facility. Average ambulance response time in Florida's rural counties was 9 minutes and 15 seconds as compared to a national response time of 10 minutes and 5 seconds for rural urban/city classifications. The primary needs identified by Florida's rural EMS providers (other than local and state funding support for staff, replacing ageing vehicles, equipment, and supplies) is recruitment and retention of personnel, and training clinical and management staff.
Florida also has a statewide rural EMS provider network (Florida Association of Rural Emergency Medical Services Providers, FAREMS) that was developed with assistance and support from FORH and Florida's EMS Program in 2005. FAREMS assists rural county EMS agencies by addressing their common problems such as medical direction, recruitment and retention of staff, management and clinical staff training, and serves as a voice to advocate for rural EMS agencies at the state level.
Florida's trauma system is composed of seven level 1, nine Level 2, and six pediatric trauma centers that serve 19 trauma districts. These trauma centers treated 34,211 trauma patients in 2011-12 of which 2,700 (7.9%) were estimated to be from rural areas. FORH has been working closely with the state's Office of Trauma since 2005 on a variety of activities to support the improvement of trauma services in rural areas. FORH previously funded rural trauma team training in Florida's 13 critical access hospitals and is continuing to provide support for training at the remaining rural hospitals. In addition, FORH coordinated the purchase of trauma crash carts for 15 rural hospitals that had completed the rural trauma team training using federal hospital preparedness grant funds
The availability of health manpower to serve Florida’s growing population continues to be a problem but the problem is not confined to just rural areas. As of December 2012, there were 36 federally designated medically underserved areas in Florida, 12 of which were rural counties. All 67 Florida counties have at least one underserved geographic area or population. In addition, there were 121 designated primary care shortage areas located in 65 counties. According to the federal shortage designation statistics, the number of Floridians without access to a primary care provider is 4,190,410 or 26.6 percent of Florida’s population. Sixty-one counties also have Dental Health Professional Shortage Areas and 44 counties have Mental Health Professional Shortage Areas, most of which are rural. The availability of health manpower in Florida’s rural areas is particularly acute as the majority of existing providers are nearing retirement age. The ratio of population to practicing primary care physicians in 2011 for the 30 rural counties (2,067 per physician) was almost twice that for the state as a whole (1,304 persons per physician) and ranged from 905 in Union County to 5,577 persons per primary care physician in Hardee County. One rural county (Liberty) currently had no practicing primary care physicians.
For additional information about health shortage designations, go to the Health Professional Shortage Designation web page. To find out if an area has received a federal Health Professional Shortage Designation go to the Health Resources and Services Administration web page.
The physical, mental, and oral health of Florida’s rural residents is an ongoing concern. To address these concerns, the Florida Office of Rural Health has identified priority issues and developed a Rural Health Plan to establish policy toward resolving issues relating to health and health care services for rural residents. Rural issues include:
Established by the Florida Legislature in 1991 under section 381.0405, Florida Statutes, the Florida Office of Rural Health (FORH) is charged with addressing the health care needs of the state's rural citizens. The mission of FORH, as specified by statute, is to actively foster the provision of health care services in rural areas and serve as a catalyst for improved health services to residents in rural areas of the state. FORH’s vision is the development of healthy rural communities that contribute to the quality of life of rural residents by providing opportunities for meaningful employment, life long education, cultural enrichment, recreation, safety and security, housing, and high quality health services. Our values incorporate the principles of teamwork, integrity, accountability, professionalism, quality, and caring by actively providing advocacy, resources, and technical assistance to rural communities throughout Florida.
In general, FORH’s responsibilities include:
FORH receives funding support primarily from federal rural health grant programs through the federal Office of Rural Health Policy. These federal programs are the State Office of Rural Health Program; the Rural Hospital Flexibility Program; and the Small Rural Hospital Improvement Program. In addition, Florida’s Legislature annually appropriates funding for rural health networks that is used to match federal funds.
As one of the smallest state offices of rural health in the country, FORH must make effective use of both public and private partners to carry out its activities. FORH’s key public partners include programs within the Department of Health (DOH) and other state and federal agencies. Private partners include health interest groups, associations, and organizations with an interest in rural health.