As the struggle for increased health care access is approaching a new peak of intensity, advocates for universal health care should understand the role of community health clinics in caring for vulnerable communities.
Advocates have dedicated the vast majority of the debate to reforming the financing of health care. Whether they support a national single-payer approach as contemplated in Rep. John Conyers’ HR 676 or a Cuba-style nationalized health care system, the debates remain centered on how we pay for health care. However, to truly consider how to reform health care in this country, it is critical to examine the other side of the debate as well: how health care is delivered.
Financing reform is mainly focused on who pays for health care — and through what mechanisms. Health care delivery focuses on the point of service and the development of an infrastructure where people actually can go for comprehensive services, especially primary health care.
Since the 1965 opening of the nation’s first community health center (CHC) in Boston’s Columbia Heights housing project, CHCs have been the flagship of the nation’s health care delivery safety net.
CHCs are local, nonprofit, community-owned, federally funded health care providers. Currently, there are more than 1,000 centers serving over 15 million people in every state and territory of the country.
Roughly half of CHC patients live in rural areas, while the other half tend to live in impoverished inner cities. Seventy-one percent of patients have family incomes at or below poverty, 40 percent are uninsured and 31 percent depend on Medicaid. Nearly 70 percent are racial and ethnic minorities, and roughly a third are served in a language other than English. Most importantly, CHCs never turn anyone away, regardless of insurance status and ability to pay (and increasingly, immigration status).
CHCs have been continuously shown to improve health outcomes for our nation’s most vulnerable patients and to reduce health disparities. Communities served by CHCs have lower rates of hospitalization because they are able to access comprehensive preventive services. Furthermore, these communities have 10 percent lower infant mortality rates than similar communities without health centers. Centers have been shown to provide the highest quality care with high efficiency — patients who receive care in CHCs cost the Medicaid program, on average, 30 percent less yearly than other Medicaid beneficiaries.
Clearly, health centers have greatly benefited the American public, especially the most vulnerable. There are, however, serious challenges. Despite providing care for 15 million patients every year, CHCs are struggling to keep up with the mounting demand for their services and the skyrocketing cost of health care. As the number of uninsured individuals continues to rise, a greater percentage of care provided by CHCs will be uncompensated. Another important challenge is that while CHCs provide comprehensive primary-care medical services, communities also desperately need improved access to mental and dental health services. Most CHCs do not have the resources to provide these services and until they do, patients’ overall health will be negatively affected.
Opportunities exist to address these challenges and expand the scope and reach of CHCs. This year, the federal program that provides funding for CHCs must be reauthorized by Congress. While CHCs have enjoyed wide, bipartisan support in the past, pressure is needed to improve the program. The National Association for Community Health Centers, which advocates on both health care financing and delivery issues, is calling for an additional $200 million this coming fiscal year (for a total of $2.2 billion) to begin expanding the capacity of CHCs to 30 million patients by 2015.
Protecting the victories of the community health center movement and working to overcome the barriers faced by our delivery system is a critical component in our struggle to build a health care system driven by patients’ needs — not Wall Street’s.
Flávio Casoy works on universal health care with the American Medical Student Association.