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State Health Reform; Health Care Costs; Community Health Centers; Health Homes


Florida's health care system faces numerous challenges: a high proportion of residents without health insurance, a declining supply of primary care physicians at the same time that the state faces a growing need for high quality and cost efficient care for uninsured persons, and a growing emphasis on medical homes, especially for culturally diverse patients with complex chronic conditions. Nearly 3.8 million Florida residents lack health insurance, while more than 8 million lack access to a regular source of primary health care.

Assuring access to timely and high quality primary health care is a key dimension of any health reform plan. The importance of focusing on primary care in health reform arises from the relationship between primary care on one hand and improved health status, reduction of population health disparities, and cost control on the other. The health care safety net represents one of the state's most important assets in any broader effort to improve the quality and accessibility of primary health care. Florida's safety net consists of hospital outpatient clinics, emergency departments, rural health clinics, public health and county volunteer clinics, and federally-qualified health centers (FQHCs). As in other states, FQHCs merit particular focus; their community location and mission and the affordability and comprehensiveness of their care make them a key foundation of primary health care reform.

FQHCs repeatedly have been found to be especially effective in terms of both cost and quality, due to their community accessibility and their ability to furnish timely and high quality comprehensive primary health care and "enabling services" such as transportation, case management, and translation, in a culturally appropriate manner.

Health centers repeatedly have been recognized for their capacity to serve as medical homes to diverse populations, particularly patients with serious and long term chronic conditions that can be effectively managed in community settings. Extensive evidence suggests significant potential savings from investing in health centers. Indeed, this analysis finds that community based primary care could result in an estimated savings of between $720 million and $794 million because of improved access, and a nearly $5 billion reduction in emergency care expenditures.

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