Health Clinics for Municipalities To Save Money?



Today as the new Fiscal Year for local governments begins, our budget “season” is over, right?

Wrong!  Our work begins again today.

There are certainly challenges.  It takes innovative and balanced approaches, combined with a large dose of cooperation, to tackle these challenges.  No city can singularly or simply choose to only cut, or find efficiencies, or increase, or build, or develop, or redevelop or regionalize in the effort find or maintain financial stability.

We know the consequences are serious.  Once considered a strategy only for corporations to wrestle creditors, employees, and pensions, since 2010, 28 municipalities nationwide have sought bankruptcy protection as a last resort.

In March, I raised concerns about the pace of and sustained rise in municipal health care costs. That story is here.

Concessions have helped manage costs, but what more can we do?


Emerging Trend of Municipal Health Care Clinics


Ten years ago, the idea that urgent or walk-in clinics could be a popular alternative seemed unthinkable. Who would pass up the family tradition of waiting to get an appointment…and then waiting in a doctor’s office…and, depending on your plan, maybe seeing a doctor?

Now, clinics are in storefronts, pharmacies and grocery stores.  Brick-and-mortar hospital systems are offering urgent and walk-in clinic alternatives.  Even municipalities are embracing clinics.

According to a report, the 2012 Kaiser Family Foundation Survey of Employer Health Benefits found “29 percent of government entities with 1,000 employees or more said they offered an on-site health clinic. The same survey found that 22 percent of all [private] firms with 1,000 or more workers did so.”  Why?


  • Employees and dependents have access to localized clinics (with due regard for privacy), even allowing predictable appointment times booked on-line;
  • “Preventative medicine” is part of the employee investment in the system, and even more effective when combined with wellness incentives and rewards;
  • Employees pick up prescriptions efficiently and with no wait;
  • Significant cost savings to the municipality and employees can be achieved through high utilization rates and substantial use of generics.


Don’t Get Too Excited, Yet


Even those in support of municipal health clinics caution it may not be the correct alternative for every city.


  • If not self-insured and plan costs are rising far more slowly than the 10% average, it may not be cost effective;
  • Start up costs (depending on chosen model: RNs, LRNPs or mix of doctors with staff, diagnostic equipment available) can require a 3-5 years to recapture investment;
  • To achieve real savings, families must be comfortable with choosing clinics over their family physician for routine issues, commit to using the clinics and agree to always use available generics;
  • A clinic does not displace need for specialists or pediatricians;
  • Rural settings may benefit more than an urban market with aggressive insurance competition;
  • Without employee trust and “buy-in”, utilization rates and, therefore, savings, may fall flat.


However, clinics are more prevalent than ever.

Competition amongst and availability of clinics may provide potential opportunities for municipalities.


Multi-municipality Cooperative Approach: Too Hard or Complex?


Could savings be achieved through voluntary cooperation of like-minded cities?

If a large percentage of employees and their families live in a corridor of cities, maybe a consortium could maximize utilization rates and save most costs.

Tough issues and poor track record for city consortiums?  Yes, in some cases.

Is the analysis and cooperation complex?  Extremely, because of the diversity of medical plan designs, actuarial rates, contribution formulas, collective bargaining agreements, budgeting and politics.

But, when alternatively faced with cutting programs, services and employees, implementing furloughs and pay cuts, and/or jeopardizing sustainable commitments to retirees and our community, maybe we must work a little harder and try to maximize cooperation to help tackle health care costs.

(Mayor Michael J. Ryan, a lawyer, was elected in 2010 and has lived with his wife and two children in Sunrise over a decade.)

5 Responses to “Health Clinics for Municipalities To Save Money?”

  1. The Answer says:

    Should be studied together with the Broward Workshop’s published report recommending the merger of small cities into larger ones that provide better services at a lowered cost to taxpayers.

  2. Andy Behrman says:

    Mike, Buddy:

    What you are talking about here, for the most part as it relates to the health clinics, are for- profit urgent care and walk-ins. They have a purpose and that is to take episodic care and serve a patient. They are not replacements for practices. I want to provide a bit of information about another system in place that can help employers ensure that their employees get excellent primary care in a medical home setting, not just episodic care.

    I want to bring to your attention Federally Qualified Health Centers (FQHCs), or Community Health Centers (CHCs) as they are also called. These highly competent medical home based models serve all patients, regardless of their ability to pay. They take medicaid, medicare, private insurance and self pay (on a sliding fee scale). Now don’t go stereotyping these centers as “just clinics for poor people” , with limited services, etc. FQHCs provide high quality, comprehensive primary care including, family practice, ob/gyn, pediatrics, children dentistry (in many locations), and a long list of services. Their physicians are board certified, their clinical staffs are high caliber, and in Broward we have two main FQHCs with satellites. Across the state, Florida has 50 FQHC organizations serving patients at over 320 facilities. Over 1.1 million people were served at community health centers last year. I can tell you that many have contract relationships with employers with and/or through the company insurance products. FQHCs provide services at significantly lower costs. Counties work very closely with FQHCs around the state. While there is so much more about these centers, I just wanted you to know there are good options out there for municipalities and employers to consider. Please remember that while it is critically important for organizations to be able to reign in costs here, it is more important to make sure we can provide access to care when needed and feel confident about the provision of those service. FQHCs do both.
    And, to be fair, I should mention that I am the President/CEO of the Florida Association of Community Health Centers, serving and representing all the FQHCs in Florida.

  3. City Activist Robert Walsh says:

    Biggest question there mayor Ryan is how do we pay for all this? We need to generate more money for our cities. Start by having a “stripper tax”. Yes you want to take all your clothes off, fine as long as you have a permit issued by the city etc. It would involve the dancer, (male/female) to go to the health dept, no herpes girls, and then you get your permit to dance. No permit, no dancing. Also to generate more revenue have a “sin tax” all these bathhouses,etc, they pay say 4bucks every time you go to the bath-house. I mean if we can’t shut places like this down-start taxing them. Trust me they will all pay. 100 bucks here, 4bucks there. In the end it all adds up. No keep taxing the home owner. No more. Pay up my dancers, didlers..

  4. The Answer says:

    Walsh: I think he’s saying that by creating the clinics Sunrise would pay less for health care than they are now in return for better care. He predicts savings and better service even before considering your new tax.

  5. just saying says:

    Fort Lauderdale just handed Marathon a $1,583,000.00+ 28 month contract for a start up. Marathon does the same for Plantation.
    Hope the new clinic location is on Sistrunk