Reform plans should stress community health centers

You hear over and over, 'people need access to health care' and 'we're the only industrialized country that doesn't provide health care for all.' I take issue with the premise of these statements. Regardless of the pros and cons of present discussions on health care reform or health care insurance reform, there are programs that do provide people without health insurance access to health care, including preventive health care.

Under Section 330 of the Public Health Service Act, organizations that provide care to those unable to access traditional services are eligible for federal grant funds. These include community health centers, migrant health centers, homeless programs, and public housing programs. Those under Section 330 legislation are commonly referred to as Federally Qualified Health Centers (FQHCs) or community health centers. They provide primary care services, including preventive health care, for all age groups.

Other services that must be offered, either by the FQHC or by arrangement with other providers, include: dental care, mental health and substance abuse services, necessary transportation, and hospital and specialty care.

According to the Health Resource Services Administration, from their Website (HRSA.gov):

Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide

º checkups when you're well treatment when you're sick

º complete care when you're pregnant

º immunizations and checkups for your children

º dental care and prescription drugs for your family

º mental health and substance abuse care if you need it

Community health centers (CHCs) have been in existence for more than 40 years. Currently, there are more than 6,000 sites. They are in every state and the District of Columbia. In 2001, the President's Health Care Initiative was approved to support 1,200 new or expanded sites, and federal support doubled to more than $2 billion. In our own area, FQHCs provide care in 15 sites, in rural and urban communities.

In 2008, CHCs provided a 'health home' for more than 17 million people, 3.1 million received dental care and 678,000 were provided mental health services. The federal funds the centers receive cover about a fifth of the average cost to provide care. Other support comes from Medicare, Medicaid, the Children's Health Insurance Program, other government programs, patients' payments, insurance payments, and sources such as foundations. Patients of community health centers are charged for their care based on their ability to pay. No patient is turned away because they can't pay.

Research has highlighted the success of community health centers in improving access to care and improving health outcomes. They have succeeded in reducing the health disparities that exist among different population groups — and for containing health care costs. The World Health Organization has recognized health centers as models of primary health care delivery, and has encouraged their replication in industrialized and developing nations.

Have you heard of these centers? Did you know about the successes? Did you know about the federal funding supporting them? While community health centers vary in successes and quality of services, and while they often need more financial support to provide needed care, they do exist and are a vital part of the safety net for those without health insurance.

However, I haven't heard anything about their future. Will they continue to exist if everyone has health insurance? If so, will the funding continue to increase or will that funding be diverted to programs being considered.

Health centers exist in the Bureau of Health and Human Services.

Where is the discussion? Perhaps I've missed it.

Katherine H. Duffy, Ph.D, is a local consultant in research planning and health policy.