First posted 8/09/11 on Health Populi
As the recession drags on and millions of people in the U.S. lack health insurance, there’s a community resource that extends primary care to them that’s not in a doctor’s office: it’s in Community Health Centers (CHCs). There are over 8,000 CHCs throughout the U.S., and 20 million people use them as medical homes — providing 25% of all primary care visits for low-income people in America.
At the same time, there are 60 million people in the U.S. who do not have access to primary care due to the maldistribution and shortage of primary care providers (PCPs). Access Endangered: Profiles of the Medically Disenfranchised, a report published by the National Association of Community Health Centers, details the growing challenge of filling the gap between the limited supply of PCPs and growing demand for their services.
The most convenient place for medically disenfranchised people to gain access to primary care is in the most expensive, if accessible, health provider setting: the closest emergency room.
The fact is that funding for Community Health Centers is scaling back, due to Congress’s recent reduction in the Health Centers Program midway through FY2011. This action, combined with the fiscal fact that other funding sources at the state and federal levels are threatened due to the economy and debt discussion, endangers CHC patients’ access to health care.
Look at the second chart and glean an important reality: that people who use CHCs are more likely to have serious chronic conditions than patients of other health providers. Furthermore, the number of chronic condition visits at CHCs has increased between 2005 and 2009 for asthma, depression, diabetes and hypertension.
There is evidence that CHCs provide more effective chronic care management than other providers for many chronic conditions, albeit CHC patients tend to be poorer and at higher risk for adverse outcomes. In fact, health center patients and visits are chronic-illness related, compared with office-based physicians, according to data from the CDC’s 2008 NAMCS survey.
Health Populi’s Hot Points: CHCs are not only good for peoples’ health: they’re good for local economies, generating some 190,000 jobs and $20 billion worth of annual economic activity in their local communities. Cuts in their funding would negatively impact their neighborhoods: NAHC calculates that for every million dollar cut in federal funding, communities would lose $1.73 million in economic activity. Furthermore, CHCs are incredibly cost-effective, averting costly ER visits.
The Affordable Care Act includes provisions (especially billions of dollars worth of funding) to bolster the CHC infrastructure along with the National Health Service Corps from 2011 through 2015. The number of patients that will be served by health centers is projected to be 50 million people in 2019, more than doubling from 18.8 million in 2009. The implementation of health reform in Massachusetts led to the expansion of health centers in the state to serve uninsured health citizens.
Continued funding of CHCs will be crucial for both public health and both the national and local economies. If the emergency department in hospitals captures even more market share of primary care for the medically disenfranchised, then it will be hospital CFOs who end up paying (or eating) that bill.