Insight into
Community Health Centers
Slides from the National Association of
Health Centers’ A Sketch of Community
Health Centers were especially selected
for this presentation.
Preface
The National Association of Community Health Centers (NACHC) is pleased to present A Sketch of
Community Health Centers, an overview of the federal Health Center Program and the communities they
serve. Community Health Centers began over forty years ago as part of President Lyndon B. Johnson’s
declared “War on Poverty.” Their aim then, as it is now, is to provide affordable, high quality and
comprehensive primary care to medically underserved populations, regardless of their insurance status or
ability to pay. A growing number of health centers also provide dental, behavioral, pharmacy, and other
needed supplemental services. No two health centers are alike but they all share one common purpose: to
provide primary health care services that are coordinated, culturally and linguistically competent, and
community-directed.
Health centers play a critical role in the health care system as the health care home to 18 million* people.
Across the country health centers produce positive results for their patients and for the communities they
serve. They stand as evidence that communities can improve health, reduce health disparities, and deal with
a multitude of costly and significant health and social problems – including substance abuse, HIV/AIDS,
mental illness, and homelessness – if they have the resources and leadership to do so.
Although the Health Center Program has been very successful over the years in providing vital health care
services to those in need, the program faces many looming challenges. Rising costs, narrowing revenue
streams, and steady increases of newly uninsured and chronically ill patients threaten health centers’ ability
to meet growing need. Federal and state support is critically important to keep pace with rising costs and
escalating health care needs.
Who health centers serve, what they do, and their impressive record of accomplishment in keeping
communities healthy, is represented in the following charts.
*Includes patients of federally-funded health centers, non-federally funded health centers (health center “look-alikes”), and expected
patient growth for 2008.
OUTLINE
• Section I:
– Who Health Centers Serve
• Section II:
– Economic Costs and Benefits of Health
Centers
• Section III:
– Current Status and Projected Growth of
Health Centers to include ACCESS for ALL
Section I:
Who Health Centers Serve
56 Million People Are Medically Disenfranchised
Percent of State Population Without Access to a Primary Care Provider, 2005
DE
DC
40% or greater
20 - 39.9%
19.9 -10%
Less than 9.9%
National Average = 19.4%
FIGURE 1
Health Centers serve large numbers of
the nation’s most vulnerable, including
• 1 in 8 Medicaid beneficiaries
• 1 in 7 uninsured persons, including
– 1 in 5 low income uninsured persons
– 1 in 3 individuals below poverty
– 1 in 4 minority individuals below poverty
• 1 in 7 rural Americans
– 936,000 migrant farm workers
– 1,044,000 homeless persons
• Of the 18.4 million patients currently served by
community health centers
–
–
–
–
–
–
–
–
–
7.2 million are uninsured (38.9%)
6.5 million have Medicaid (35.4%)
1.4 million have Medicare (7.6%)
2.9 million have private insurance (15.5%)
478,000 have other public insurance coverage (including nonMedicaid expanded SCHIP) (2.6%)
400,000 are kids enrolled in SCHIP (2.2%) (and another 35,000
adults with SCHIP_
13 million are below poverty (70.4%)
16.8 million are low income (below 200% poverty) (91.4%)
8.1 million are rural (44%)
Percent of Low Income, Uninsured
Served by Health Centers, 2007
DE
DC
40% or greater (9 States and D.C.)
30-39 % (6 States)
National Average = 20%
20-29 % (18 States)
19% or less (1 States)
FIGURE 2
Most Health Center Patients are Members
of Racial and Ethnic Minorities, 2007
Race
More than one
Race 4%
Ethnicity
Asian/Hawaiian/Pacific
Islander 4%
Hispanic or Latino
34%
African American
28%
White 62%
American Indian/
Alaska Native
1%
All Others
66%
FIGURE 3
Health Center Patients vs. U.S. Population, 2007
Health Centers
80%
U.S.
62%
60%
40%
20%
15%
9%
13%
13%
5%
1% 1%
0%
Hispanic/Latino African American
FIGURE 4
Asian/Pacific
Islander
American
Indian/Alaska
Native
The Number of Health Center Patients
Preferring Care in Languages Other than
English Has Risen 64%
Number in Millions
3.6
3.8
2003
2004
4.1
4.3
4.3
2006
2007
3.3
2.6
2000
2.9
2001
2002
FIGURE 5
2005
Section II:
Economic Costs and Benefits of
Community Health Centers
Economic Costs and Benefits of
Community Health Centers
Leading the Way in Quality of Care
• Quality Care Services and Patient Satisfaction
• Reduced Cost
• Culturally Sensitive Environment
Health Center Uninsured Patients Are Half
as Likely to Go Without Care
Health Center Uninsured
100%
80%
U.S. Uninsured
96%
60%
60%
40%
40%
22%
20%
0%
Has a Usual Source of Care
FIGURE 6
4 or More Doctor Visits/Year
Nearly All Health Center Patients Report that
They Have a Usual Source of Care, 2002
FIGURE 7
Economic Costs and Benefits of
Community Health Centers
• Provide quality care for $1.55 per day (or
$562 annually per patient)
• Annual medical expenses for health center
patients are 41% lower compared to patients
seen elsewhere which saves the health care
system between $9.9-17.6 billion dollars a
year. As the health centers continue to grow,
so will the health care system savings
• Nationally, health centers generate $12.6
billion in economic benefits for their
predominantly low income, rural, and innercity communities and produces 143,00 jobs
Economic Costs and Benefits of
Community Health Centers
Reducing Cost of Overall Health Care
System by providing quality primary and
preventive health care services
The Numbers of Patients with Chronic
Conditions Is Rapidly Rising
Percent Increase
2000-2007
120%
101.1%
100%
80%
97.9%
67.7%
60%
41.9%
40%
20%
0%
Total Patients
Patients with
Diabetes
FIGURE 8
Patients with
Hypertension
Patients with
Asthma
Health Center Patients are Generally More
Likely to Have a Chronic Illness than Patients
of Office-Based Physicians
Office-Based Physician Patients
Health Center Patients
11.4%
12%
8.7%
10%
8%
6%
7.2%
4.6%
3.4%
1.2%
2.6%
4%
2%
4.0%
0%
Mental Disorders
Diabetes
FIGURE 9
Asthma
Hypertension
Economic Costs and Benefits of
Community Health Centers
• Both the Institute of Medicine and the
General Accountability Office have
recognized Community Health Centers as
effective models for reducing health
disparities and for managing the care of
people with chronic conditions such as
diabetes, cardiovascular disease, and HIV.
Health Center Uninsured Patients are Twice
as Likely To Get the Care They Need than
Other Uninsured
FIGURE 10
Economic Costs and Benefits of
Community Health Centers
Community Health Care Centers have improved
health outcomes and simultaneously lowered
the costs of treating patients with chronic
illnesses by providing cost-effective, primary,
and preventive health services thus reducing the
need for more expensive emergency room,
hospital in-patient, and specialty care. This
reduces overall health care spending and
positive health care outcomes.
FQHC: A Model for Primary
Health Care Service Centers
• Federally Qualified Health Centers (FQHC’s)
are exemplary providers of primary health
care in a culturally sensitive way
• By federal regulation, at least 51% of the board of
directors must be consumers of the health center
• Though funded with federal dollars are not
required to request proof of legal status
• And are required to be located in and serve
populations of medically underserved and/or
health professional shortage areas
Borinquen Health Care Center
• BHCC currently serves
– 35% Haitian patients
– 5% African-American patients
– 1% White, Non-Hispanic patients
– 59% Hispanic/Latino patients
BHCC Board of Directors
Racial Composition and Target Population
Representation on the Board of Directors
• 33% Haitian
• 10% White
• 57% Hispanic/Latino
* Serves 840 HIV clients; 1 Board of
Director is an HIV individual
BHCC Senior and Middle
Management
• 25% Haitian
• 15% White, Non-Hispanic
• 60% Hispanic/Latino
BHCC Multilingual Staff
• 90% of BHCC staff are bilingual
• 5% of BHCC staff are trilingual
• The telephone system, literature and
signage are printed in three languages
(English, Spanish, and Creole)
BHCC Advertisements
• Advertisements are placed in the language
and media depending on the target
population, for instance
– Haitian population listens to the radio as a
prime source of information communication
– Hispanic/Latino population watches
Hispanic/Latino television networks and/or
read newspapers related to their particular
country/region of origin
Section III:
– Current Status and Projected Growth of
Health Centers to include ACCESS for ALL
Health Center Growth between
2000-2007
 The number of patients treated by health
centers increased by 67%
 The number of patient visits to health
centers increased 64%
 The number of low income patients at
health centers grew 76%
 The number of uninsured patients grew
62%
Community Health Centers
• Health centers currently provide over 72
million patient visits annually
BHCC: A New Generation
Community Health Center
• Number of Users in 2008
– Male: 6,164
– Female: 9,733
• Patients by Ethnicity in 2008:
– Hispanic/Latino: 9,167
– Other: 6,730
BHCC: A New Generation
Community Health Center
• Payor Sources in 2008:
–
–
–
–
Self-Pay/uninsured: 11,797
Medicaid: 3,244
Medicare: 735
Private Insurance: 121
• Number of Visits by Department in 2008:
–
–
–
–
–
Adult Medicine: 23,086
Pediatrics: 11,471
OB/GYN: 9,887
Dental: 7,496
Behavioral Health: 4,104
BHCC: A New Generation
Community Health Center
• Number of Users EXPECTED in 2009
– Male: 9,300
– Female: 14,500
• Patients by Ethnicity EXPECTED in 2009:
– Hispanic/Latino: 15,700
– Other: 8,000
BHCC: A New Generation
Community Health Center
• Payor Sources EXPECTED in 2009:
–
–
–
–
Self-Pay/uninsured: 16,000
Medicaid: 5,000
Medicare: 1,100
Private Insurance: 1,700
• Number of Visits by Department EXPECTED in
2009:
–
–
–
–
–
Adult Medicine: 26,400
Pediatrics: 18,000
OB/GYN: 11,100
Dental: 8,600
Behavioral Health: 4,800
Primary Care Physician Vacancy Rates at
Health Centers, 2004
Family Physicians/General Practitioner
Internist
30%
Pediatrician
26.6%
20.8%
Psychiatrist
25.1%
22.6%
21.5%
19.0%
20%
15.7%
13.3%
10%
OBGYN
9.1%
8.8%
14.1%
12.1%
8.8%
9.2%
7.4%
0%
Total
Rural
FIGURE 11
Urban
Community Health Centers
means ACCESS for ALL
If funding for Community Health
Centers Programs by 15 percent
annually for 18 years, by 2015
health centers will serve 30
million patients
REFERENCES
• Figure 1: The Robert Graham Center. Health Services
and Resource Administration (HPSA, MUA/MUP data,
2005 Uniform Data System), 2006 AMA Masterfile,
Census Bureau 2005 population estimates, NACHC
2006 survey of non-federally funded health centers.
• Figure 2: National data from: Kaiser State Facts.
Distribution of the Nonelderly Uninsured by Federal
Poverty Level, 2007.
http://www.statehealthfacts.org/comparebar.jsp?ind=1
36&cat=3 . Based on Bureau of Primary Health Care,
HRSA, DHHS, 2007 Uniform Data System.
REFERENCES
• Figure 3: Federally-funded health centers only.
2007 Uniform Data System, Bureau of Primary
Health Care, HRSA, DHHS.
• Figure 4: Based on Bureau of Primary Health
Care, HRSA, DHHS, 2007 Uniform Data System;
U.S.: Kaiser Family Foundation, State Health
Facts Online, www.statehealthfacts.org. Based on
U.S. Census Bureau 2006 and 2007 March
Current Population Survey. US Census Bureau,
Table 4. Annual Estimates of the Population by
Race Alone and Hispanic or Latino Origin for the
United States, July 2007, www.census.gov.
REFERENCES
• Figure 5: Federally-funded health centers only.
2000-2007 Uniform Data System, Bureau of
Primary Health Care, HRSA, DHHS.
• Figure 6: Shi, L and Stevens, GD. “The Role of
Community Health Centers in Delivering Primary
Care to the Underserved.” April-June 2007 JACM
30(2):159-170.
• Figure 7: AHRQ, “Focus on Federally Supported
Health Centers,” 2002. National Healthcare
Disparities Report. http://www.ahrq.gov/
REFERENCES
• Figure 8: Federally-funded health centers
only. 2000-2007 Uniform Data System,
Bureau of Primary Health Care, HRSA,
DHHS.
• Figure 9: Private Physicians from 2006
NAMCS (CDC National Center for Health
Statistics, 2008). Based on Bureau of
Primary Health Care, HRSA, DHHS, 2006
Uniform Data System.
REFERENCES
• Figure 10: Politzer, R., et al. “Inequality in
America: The Contribution of Health Centers
in Reducing and Eliminating Disparities in
Access to Care.” 2001. Medical Care
Research and Review 58(2):234-248.
• Figure 11: Rosenblatt R, Andrilla H, Curtin T,
and Hart G. “Shortages of Medical Personnel
at Community Health Centers.” 2006. JAMA,
Vol. 295, No. 9: 1042-1049.