Alligator Healthcare

As I write this entry I am actually on a beach visiting my wife’s family in Florida. We do this every August or September to assure that we will be here during peak hurricane season. This eliminates the need to visit Disney World in order to experience a thrill.

There is another way to get a thrill in Florida. Alligators are ubiquitous. We stay in a hotel near a lushly landscaped outlet shopping center and sometimes have a snack in the center’s food court. There are places to munch your corn dog outside next to ponds. However, there are signs warning you while you are munching the corn dog to make sure an alligator is not munching you.

From the perspective of this Californian the healthcare world in Florida is wild and wooly in comparison to more staid California. At home there has been so much consolidation between hospitals and physicians that whatever competition that exists is at a level relatively remote to patients. Not so in Florida where the competition is like alligators staking out territory in the swamp.

Florida, of course, has a population with a relatively large proportion of senior citizens who are full time residents, refugees from high tax states in the eastern portion of the country. They are augmented every winter by snowbirds, seniors who are escaping harsh winters. Together they make a large market for healthcare providers. They also lower the average speed on freeways to about 30 miles per hour. Early bird dinners at 3 in the afternoon, though, are a real bargain.

The competition for patients makes for innovation. It was in Florida years ago that I first encountered the concept of a medical fitness center for both the healthy older adult and the rehabilitating senior. It was a beautiful facility and well utilized by people of a wide age range with programs tailored to the needs of the post-20s crowd. The medical fitness center shared a large building filled with outpatient services of its sponsoring hospital which was located on the other side of the city. A competitor’s hospital was nearby.

NorthBay Healthcare took its inspiration for its HealthSpring medical fitness center from such facilities. Like in Florida, the medical fitness center is part of a much larger outpatient complex. You can learn much by seeing how things are done elsewhere.

Then there are the physicians. The merger of physicians into hospitals to form integrated healthcare delivery systems is much less common than in California. In many instances, they compete with hospitals by operating various kinds of outpatient services. The hospitals, in turn, respond by opening their own centers. Patients have more choices and there is a degree of price competition although with the many Medicare patients such competition is limited.

Florida is still one place that encourages the utilization of hospital emergency services by posting on large electronic billboards on busy streets the current waiting times to be seen in the emergency service. These billboards are frequently located in their competitor’s territory. I have contended in this space that encouraging the use of hospital emergency services may be good from both a healthcare and marketing perspective (see “Excommunicated”, February 26, 2019). Florida hospitals certainly seem to think so given the characteristics of the populations they serve.

On this most recent trip I ran into the concept of free standing urgent care centers for children. I have not seen one of those in Northern California and certainly not twelve as is operated by one Florida healthcare system in an area with about the same population as the Bay Area. Their centers serve patients up to twenty-one years. The website for the centers show the current waiting time for each site. The evening I looked the longest wait was just eighteen minutes. Think about that if you come home from work to a sick child! This is the kind of idea which before I hit the beach always got me thinking and excited.

Alas, there is one kind of competition in Florida which I hopes stays there. Florida leads the nation in Medicaid and Medicare scams foisted on the unsuspecting public by con men and unscrupulous physicians. These kinds of alligators need to remain in the swamp.

I find Florida healthcare for the most part to be a refreshing change from California where competition is much more muted. We need a few alligators here not including the ones in Sacramento.