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The National Health Policy Forum’s site visit to Miami focused on the complex factors that drive health care spending and is the latest in a series on the dynamics of health care markets. Miami has long been recognized as having among the highest Medicare per capita spending in the country, along with high rates of uninsured, strong managed care presence, and a history of health care fraud. This colorful health care market brings into stark relief many of the reasons for high and growing health care spending across the country. It also highlights several issues involved in building and maintaining adequate capacity to care for the newly insured as health care reform is implemented. Site visit participants toured the sprawling public health system, a state-of-the art Medicare Advantage clinic that caters to the Cuban community, and neighborhoods known for housing high-billing pharmacies and home health agencies that provide few, if any, legitimate services. These and other opportunities to interact with local providers and health care stakeholders gave participants insights into the complexities and unique features of health care markets.

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