An Overview: Health Centers at the Crossroads

Abstract

Health centers' flexibility in meeting changing political and economic demands throughout their history has allowed them to evolve and expand. In 1997, they served 8.3 million patients--40% uninsured and 35% Medicaid recipients. Thus far, most centers have been able to balance their mission of serving the underserved with economic survival. However, their future viability is threatened, by downward pressure on revenues, coinciding more frequently with growing numbers of uninsured patients. The centers' value as essential safety net providers, their adaptation to marketplace realities and their performance in terms of cost and quality outcomes appears to justify the increased subsidy that may be needed for continued operation.

America's Health Centers: Reducing Racial and Ethnic Disparities in Perinatal Care and Birth Outcomes

“…In addition to blacks, this study found decreases in LBW for Hispanics (5.6% vs. 6.5%) and Asians (6.6% vs. 7.5%) in CHCs compared to the general U.S. population. These decreases were all the more impressive due to the overall higher risk profiles of those attending CHCs (Forrest and Whelan 2000;Freeman, Kiecolt, and Allen 1982;Gardner 1993;Lefkowitz and Todd 1999;Regan et al 2003), and were still lower than the white LBW rate in both CHCs (8.2%) and in the national low-SES population (9.1%). These better overall birth outcomes for Hispanics versus whites, even among vulnerable groups in CHCs, have been previously attributed to acculturation factors (Callister and Birkhead 2002).…”

“…Overall, CHCs had LBW rates that were similar to the total U.S. population (7.5% vs. 7.7%) and lower than the national low-SES population rate of 8.2% in 2001. This is impressive given that CHCs largely serve uninsured and low-SES populations who are at greater risk of poor outcomes (Forrest and Whelan 2000;Freeman, Kiecolt, and Allen 1982;Gardner 1993;Lefkowitz and Todd 1999;Regan et al 2003). This study further found that black-white disparity in LBW rates (inclusive of VLBW) was 3.3 percentage points in CHCs compared to 5.8 percentage points among low-SES mothers nationally and 6.2 percentage points for the total U.S. population.…”

“…Since their inception in the 1960s, America's community health centers (CHCs) have served as a primary care safety net for underserved populations in both inner-city and rural areas (Freeman, Kiecolt, and Allen 1982;Gardner 1993;Lefkowitz and Todd 1999;Regan et al 2003). The central mission of CHCs is to increase access to community-based primary care services and improve the health status of vulnerable populations.…”

Barriers to Providing Diabetes Care in Community Health Centers

“…Much morbidity could be prevented, however, if an efficient system of primary care existed for patients in medically underserved areas (1). To this end, in 1965, the federal government funded neighborhood health centers that were later codified as community, migrant, and homeless health centers through section 330 of the Public Health Service Act (2). The ϳ1,000 current federally supported health centers are an important source of primary care for 11 million medically underserved Americans (3).…”

The diversity of prevention and health promotion services offered by Quebec Community Health Centres: a study of infant and toddler programmes

“…Research conducted on community health centres as a type of health service delivery organisation has indeed shown that their preventive and health promotion services can be vulnerable in a context of budgetary cutbacks. In the USA, for example, reductions in funding for many community health centres in the early 1970s had a negative impact on PHP services; sectors such as environmental health services, nutrition and health education were reduced or eliminated (Patton 1990, Lefkowitz & Todd 1999). A recent analysis of the situation in another Canadian province (Ontario) expressed concerns about the impact that upcoming reforms might have on the capacity of community health centres to influence health determinants (Suschnigg 2001).…”