emergency departments and hospitals.[1]  Additionally, uninsured people living within close proximity to a health center are less likely to have an urgent unmet medical need.[2] 

Health centers have been found to improve patient outcomes and reduce racial and ethnic disparities in health care.[3]  For example, the health center low birth weight rate for African American patients is lower than the national rate for African American infants.[4]  Also, health centers show demonstrable success in chronic disease management, and a high proportion of health center patients receive diabetes care.  Researchers have also found that quality of care (e.g., patient rates of blood pressure control) delivered by health centers was comparable to and sometimes better than the quality of care delivered in other settings for the underserved. 

In addition, Medicaid beneficiaries receiving care from a health center were less likely to be hospitalized than Medicaid beneficiaries receiving care elsewhere.  Health center Medicaid patients were 11 percent less likely to be inappropriately hospitalized and 19 percent less likely to visit the emergency room inappropriately than Medicaid beneficiaries who had another provider as their usual source of care.[5]

Health Information Technology and Quality

A key goal of HRSA’s is to transform systems of care for safety net populations through the effective use of Health Information Technology (HIT).  In FY 2007, HRSA awarded a total of 46 grants worth $31.4 million to expand the use of health information technology at health centers.  Grants were awarded to support implementation of Electronic Health Records (EHRs) at health centers and in networks that link multiple health center grantees, to help health centers in planning activities that will prepare them to adopt EHR or other HIT innovations such as electronic prescribing, physician order entry, or personal health records.  As a condition of grant funding, recipients are required to utilize certified HIT products where available and to implement data standards that will make HIT interoperable.

HRSA is currently involved in an agency-wide effort to improve quality and accountability in all HRSA-funded programs that deliver direct health care.  Our vision is to have HRSA-funded programs provide the highest-quality clinical care in the entire American health care sector.  One of the key steps we have taken in this area is to establish a core set of clinical performance measures for all health centers.  Among health centers, advancing quality is not a new concept.  Health centers have been on a quality quest since their inception, grounded in the principles of community-oriented primary care.

NHSC:  Thirty-Five Years of Quality Service to America

The NHSC was created with the Emergency Health Personnel Act of 1970 to address a need:  too few clinicians were training in needed specialties, practicing in unserved areas, or seeing people who needed health care.  Its charge was simple:  place clinicians in areas of need.  Within six months of its initial operation in 1972, the NHSC had placed 180 volunteer clinicians in over 100 communities.  Also in 1972, the Emergency Health Personnel Act Amendments established the NHSC Scholarship Program, which linked award of a full scholarship (tuition, fees, stipend) to a commitment on the part of the scholar to serve in an underserved area.  The NHSC continued to place volunteers in the interim years while the first scholars were chosen, completed their training, and began service in 1977.

 By 1980 the NHSC had a Field Strength of 2,080 in service to the underserved.  By the mid-1980s, it became clear that despite an increase in the number of physicians nationwide, the problem of lack of access was becoming acute among increasingly larger segments of the population.  In 1987, the NHSC was augmented by the establishment of the NHSC Loan Repayment Program.  This new Program recruited already trained and qualified primary care clinicians by offering incremental annual payments to be applied against their student loans in return for service in an underserved area.  This enabled the NHSC to fill an immediate need for a clinician, as opposed to waiting for one to be produced out of the scholarship pipeline. 

In 1990, the NHSC was reauthorized for ten years, and by 1994, the NHSC, in response to community demand, expanded eligibility for loan repayment to several mental and behavioral health disciplines.  In 2000, the NHSC conducted a large study of NHSC alumni (i.e., those clinicians who had completed their service obligation up to 15 years before).  Fully 52 percent of those clinicians continued to serve the underserved in their practice.  The NHSC of 2002 had a Field Strength of 2,765, of which approximately 54 percent were primary care physicians.  Also in that year, the NHSC was reauthorized by Congress through fiscal year 2006, and was given greater flexibility to distribute funds between the Scholarship and Loan Repayment Programs.  This change in the law enabled the NHSC to direct more funding to loan repayment, with the effect that in 2006 the NHSC Field Strength grew to 4,109, a nearly 50 percent increase in the Field Strength since reauthorization in 2002.  This is due in large part to the increased flexibility the program now has to shift more funding to help meet the immediate needs of underserved communities and vulnerable populations.  In response to communities’ demand for services, the number of NHSC dentists increased by 62 percent and the number of mental and behavioral health professionals grew by 176 percent from 2002 to 2006.  In addition, in 2006, as throughout the history of the Program, approximately 60 percent of NHSC clinicians served in rural America.

The current NHSC statute sets a funding floor for the Scholarship program, 10 percent of total NHSC appropriations.  HRSA supports this existing statutory authority that provides us the administrative flexibility to determine the level of support between the Scholarship and Loan Repayment Programs, in response to community requests and areas of greatest need.  This flexibility also helps us to respond quickly to changes in the health care environment across the U.S.  

Current NHSC Field Strength

As a significant source of highly qualified, culturally competent clinicians for the Health Center Program, as well as other safety net providers, the NHSC can build on its success in assuring access to residents of Health Professional Shortage Areas (HPSA), removing barriers to care and improving the quality of care to these underserved populations.  The NHSC Program is working with many communities in partnership with State, local, and national organizations to help address their health care needs, and help reduce the health disparities gap.  The current Field Strength (clinicians in service to the underserved) of the NHSC is 4,109.  Of this amount, 2,051 are in HRSA grant-supported health centers, with the remaining 2,058 NHSC clinicians in “free-standing” sites.  It is noteworthy that the percentage of NHSC clinicians working in health centers has been at 50 percent or higher since 2004, the highest, and longest sustained, percentage in recent years. The NHSC made 1,100 NHSC placements in HPSAs in FY 2007—in response to community requests and the level of need.  

Other NHSC Activities

In getting the word out to the communities about our programs, the NHSC’s Student/Resident Experiences and Rotations in Community Health (SEARCH) Program is offered to State-based organizations on an annual, competitive basis.  Under this program, health professions students and medical residents get experience in primary clinical care.  This potentially leads to greater numbers of clinicians serving in primary care centers, including health centers.  In FY 2007, 20 States and Puerto Rico participated in SEARCH at a funding level of $1,823,068. 

The NHSC Ambassador Program is a membership organization comprised of a dedicated group of volunteers on campuses and in communities across the Nation.  These volunteers, or “Ambassadors,” work in partnership with the NHSC, serving as mentors and trainers to Scholars and Loan Repayers. 

The word is spreading.  The NHSC’s recruitment efforts have led to its Job Opportunity List utilized so successfully that more vacancies were filled last year by non-NHSC clinicians than by NHSC Scholars and Loan Repayers.     

Conclusion

We are proud of the accomplishments of the Health Center Program and NHSC.  These programs are delivering care to millions of underserved Americans with few health care alternatives.  We look forward to working with the Committee in reauthorizing these programs.  I would be happy to answer any questions at this time.

Last revised: August 29,2008