Health fees could increase with approval of city budget

Friday, September 12, 2008 | 3:18 p.m. CDT

COLUMBIA — The Columbia/Boone County Health Department is set to increase fees for immunization and tuberculosis testing, as well as introduce a $20 fee for sexually transmitted disease visits for non-Boone County residents, if the City Council approves its budget proposals for 2009. The fee revision will be the first in five years for the department.

The proposal would increase costs of adult immunizations from $5 per dose to $10 per dose. For children 18 years and younger, the Health Department also currently charges $5 in vaccine administration fees per visit, but those fees are proposed to increase to $10 per visit.

"We provide highly subsidized services. But every year we revisit the charges and adjust them if necessary so as not to cut services," said Stephanie Browning, director of the Health Department. "The costs are going up, and we work on a slim budget."

The proposed fee increases for the clinical and nursing segments along with animal control and environmental health are expected to bring in $90,090 in additional revenue to the Health Department. The clinical and nursing division alone hopes to generate around $40,000 annually with the increase, said Mary Martin, public health manager. The proposed 2009 budget of the Health Department is $3,156,994, she said.

In the first 11 months of the current fiscal year, the clinic has vaccinated 4,842 children.

"The costs of doing business are going up, and the federal and state grants have not increased," Browning said. "Decisions are being very tough to make, and the increase will offset operational costs."

A child less than 2 years old often gets three vaccines in one visit for measles, mumps, and rubella, polio and tetanus.

"Children often get more than one vaccine, and so the cost of a child being vaccinated is quite subsidized when you compare to the typical adult who only gets one vaccine," Browning said.

Martin added, "The public health clinic, therefore, hopes to cater to the uninsured or under insured people rather than those who are covered by insurance.

"Children on Medicaid are not charged any fees as Medicaid is billed. If a person is unable to afford the fee, we have social service workers to discuss insurance for the children."

The clinic is open to free STD testing on Tuesday nights and by appointment five days a week. The most common tests are for gonorrhea, chlamydia, syphilis and HIV.

"The fee may deter some people, but our proposed fee is lower than any of the surrounding counties and is still free to county residents," Martin said.

The clinic receives 30 to 40 patients on Tuesday nights and another 40 to 50 patients throughout the week, Martin said. Of that, 15 percent of the patients were from outside of the county, she said. Students at educational institutions such as MU, may be a resident of other counties or even states, but Martin said they are considered Boone County residents.

The clinic also receives students from Truman State University in Kirksville, Missouri State University in Springfield and the University of Central Missouri in Warrensburg for STD tests, Martin said. The clinic's facilities are also utilized by residents from Boonville, Jefferson City, Moberly, Wellsville and other towns.

"Many of these out-of-county residents come to the STD clinic in Columbia to preserve their anonymity," Martin said. "Though we do make a picture ID of the patients, we do not do background checks."

STD visits per year have been steadily increasing over the past few years. The clinic treated 1,242 patients in fiscal year 2002, and that figure rose to 2,659 in fiscal year 2007. In the first 11 months of the current fiscal year, the clinic attended to 2,502 patients.

The Public Health and Human Services Department has also proposed increasing the annual inspection fee for food establishments. The increase varies from $10 to $20 depending on the annual gross receipts of the food establishments. There is also a proposal to introduce a food establishment plan review fee.

"We have not previously charged a fee for a plan review," said Gerald Worley, environment health director for the Health Department. "Plan reviews take up considerable staff time to review the plans, discuss the plans with the owners/developers and do the field inspection required for new facilities. The fee proposals help offset these operational costs."

The food establishments are classified as low-risk, medium-risk or high-risk facilities. The proposed food establishment plan fees will vary from $100 for low-risk facilities to $300 for high-risk ones.

"We use FDA recommendations on risk to the public while classifying the food establishments according to their risk factors," Worley said.

The restaurant industry in Columbia is not happy with the fee proposals.

"Government shouldn't put on excessive fees, especially when restaurants are struggling to stay open in the state, just because they are not raising much tax revenues," said Richard Walls Jr., president of the Mid-Missouri Chapter of the Missouri Restaurant Association. "It is unfair to individual restaurant owners."



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