A significant portion — about $353 million — is for new equipment, everything from hospital beds and patient room furniture to CT scanners, cardiology X-ray systems and oncology radiation devices.

About $130 million is for computers and software to integrate electronic medical records, clinical information and physician decision-making tools across Jackson’s six hospitals, 12 specialty care centers, and health clinics.

Healthcare experts say Jackson certainly needs to upgrade its facilities, some of which have not been repaired or renovated since the 1970s,

But they emphasize that Jackson’s long-term success depends as much on its administrators’ ability to reverse years of declining admissions in paying patients, and to prepare for likely reductions in government funding and other still-unknown effects of federal healthcare reform.

Jackson administrators pulled the hospital system out of a financial tailspin by cutting staff, reducing operating costs, aggressively enrolling indigent patients into Medicaid and other strategies.

But if the hospital system is going to thrive, it will have to grow, said Sal Barbera, a former hospital executive who teaches at Florida International University.

“All the people that are uninsured now and will have insurance through Obamacare, and they now have a choice to where they go, are they still going to be going to Jackson’s ER? I don’t know,’’ he said. “This could be what they’re preparing for. Even though there’s more patient funding out there, they have to make sure they’re in the game with getting those patients.’’

Barbera said he is encouraged by Jackson’s plan to open new urgent care centers throughout Miami-Dade, because the hospital system’s future also will depend on its ability to expand primary care, partly to cut down on more expensive care for the uninsured in emergency rooms, partly to attract more paying customers to clinics that could feed patients into Jackson’s hospitals.

Indeed, many hospital chains are aggressively buying physician practices, preparing to form accountable care organizations that are emphasized in the Affordable Care Act.

Jackson’s plan to renovate doctor’s offices and facilities will attract more physicians who will refer patients for hospitalization and medical services to the public hospital system, Migoya said.

But Jackson will still have to treat the uninsured and carry out its broad mission to help the community — a mission that administrators say costs far more than the government support it receives.

Jackson not only cares for every patient that enters the emergency room, as required by federal law. It also runs two nursing homes, operates clinics and provides healthcare to Miami-Dade inmates.

In 2012, Jackson spent $565 million on these community benefits but received only $425.8 million in government support — a gap of $139.2 million, according to an independent valuation of the hospital system.

That government support included about $202.5 million from a half-penny sales tax approved in 1991 for Jackson support; $133.3 million in Miami-Dade property taxes; and $90 million in federal and state funding.

Many believe that Jackson’s main problem is reversing the trend of declining admissions. In the past four years, in-patient admissions have dropped 21 percent. But Migoya counters that while in-patient admissions are down, the system’s outpatient services are exceeding expectations.