Reform Proposal3: Community Health Centers

Our third reform on outpatient and primary care will emphasize and focus on increasing the amount of community health centers. Community health centers (CHC) are non-profit organizations that operate under the US Public Health Services and the US Department of Health and Human Services. Required by law, CHCs are located in medically underserved areas throughout the U.S. and they work to enhance the health status of all people seeking care regardless of their abilities to pay. These areas areas are frequently characterized by geographic, economic, or cultural barriers that limit access to primary health care for a substantial portion of the population. CHCs alter their services to family-oriented primary and preventative health care (Shi and Singh 2008, 272).
The original community health centers were designed with significant community involvement to ensure they remained responsive to specific community needs. In 1965 funding was approved for the first two neighborhood health centers in Boston (1965) and Mound Bayou, Mississippi (1967). CHCs are located in all 50 states with 890 health center grantees that provided services through 3,600 inclusive health care sites (Taylor, 2004). CHCs provide a wide variety of care including dental, obstetric/gynecologic, family practice and pediatric based on the demand for care. Many centers have created long-standing systems of care that include outreach programs, case management, transportation, translation services, alcohol and drug abuse screening and treatment, mental health services, health education, and social services (Shi and Singh 2008, 272). With a combination of low incomes, linguistic barriers, and often poor status, the CHCs’ patients receive access to comprehensive primary care as well as enabling services (Taylor, 2004). CHCs follow a sliding-fee scale depending on the patient’s income. As shown by 2004 national data, more than 40 percent of the patients served by CHCs are uninsured, 73 percent have incomes below 200 percent of the federal poverty level, and about 60 percent are racial/ethnic minorities. (Shi and Singh 2008, 272) CHCs enhance access to patients health status and preventative care, they provide cost effective care to the population, and they work to decrease health disparities of the poor and underserved population. With an abundance of community health centers, the health disparities seen in the underserved population would be diminished even more. The growth of CHCs would help those 1,500 counties across every state that have disenfranchised populations and do not have a single health center.
Nearly eighteen billion dollars a year is wasted on unnecessary visits to hospital emergency rooms for health care that could and should be provided by a health center (nachc.com). Emergency rooms across the United States are being overused for non-emergency care. In areas without CHCs, people opt for the emergency room to seek health care. Non-urgent emergency room use is a problem from both a health care cost and quality standpoint. It was estimated by the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS) that there was a reported 114 million visits to hospital emergency rooms that year, with only 15% of these visits considered emergencies. (Brim 2008, 15) While some people choose to take advantage of emergency rooms, there really are other options that can be cost efficient and offer much better care. Emergency rooms lack the continuity of care that a community health center provides and they are not intended to promote the prevention that a CHC can provide. By adding more CHCs, the uninsured would be able to seek primary care without having to overcrowd the emergency rooms. In turn, emergency rooms would have fewer patients using them, which would increase the quality of care to those who are in urgent need of care by an emergency room. The overall quality of care that emergency rooms provide would be greatly influenced and help to lower the costs of emergency rooms as the non-urgent use of them declines.
A study was done by The Journal of Rural Health (2009) in Georgia to compare uninsured emergency department visit rates between rural counties that have a CHC clinic site and rural counties without a CHC presence. The study was completed to see if findings pertaining to primary care access did in fact reduce emergency department visit rates. The data collected showed that uninsured emergency department visits represent a significant problem in Georgia. National data shows a positive association between primary care shortage densities and emergency visit densities.
CHCs play an important role in reducing access barriers to primary care services in rural areas. Rural CHC patients are more likely to receive certain preventative services and experience lower rates of low birth weight. It is clearly recognized that the importance of CHCs in improving access to primary care for underserved populations is at an all time high.

References:
Rust, George, Peter Baltrus, Jiali Ye, Elvan Daniels, Alexander Quarshie, Paul Boumbulian, and Harry Strothers. "Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties," Journal of Rural Health 25, no. 1 (December 2008): 8-16.
Taylor, Jess. "The Fundmentals of Community Health Centers." National Health Policy Forum (2004). 22 Mar. 2009 https://uwlax.edu/exchweb/bin/redir.asp?URL=http://www.aoa.org/documents/Fundamentals-of-CHC.pdf

Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed., pp. 274-275). Sudbury, MA: Jones and Bartlett Publishers.
Brim, Carla. 2008. A descriptive analysis of the non-urgent use of emergency departments. Nurse Researcher 15, no. 3: 72-88.

Community Health Centers: Meeting Rural Health Needs. (2009 ,January). Retrieved March 23, 2010, from http://www.nach.org/Health%20Center%20Services.cfm