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Health Centers: America's Primary  Care Safety Net Reflection on Success, 2002-2005 Health Resources & Services Administration US Department of Health and Human Services

The Health Center Program: An Overview

For more than 40 years, health centers in the United States have delivered comprehensive, high-quality primary health care to patients regardless of their ability to pay. During that time, health center grantees have established a tradition of providing care for people underserved by America's health care system: the poor, uninsured, and homeless; minorities; migrant and seasonal farmworkers; public housing residents; and people with limited English proficiency.

Federal support for entities that would later be called health centers began in 1962 with passage of the Migrant Health Act, which funded medical and support services for migrant and seasonal farmworkers and their family members. Two years later, the Economic Opportunity Act of 1964 provided Federal funds for two "neighborhood health centers," which were launched in 1965 by Jack Geiger and Count Gibson, physicians at Tufts University in Boston.1

Those first two centers created an innovative new model of community-based, comprehensive primary health care that focused on outreach, disease prevention and patient education activities. The early centers also promoted local economic development, job training, nutritional counseling, sanitation, and social services. Most importantly, they established one of the enduring principles of the program: respect for patients and communities and their involvement in the operation and direction of health centers.2

In the mid-1970s, Congress permanently authorized neighborhood health centers as “community health centers” and “migrant health centers” under sections 329 and 330 of the Public Health Service Act. Congress expanded the health center system in the later years of the 20th century. In 1987 the Health Care for the Homeless program was created by the McKinney Homeless Assistance Act and 3 years after that the Public Housing Primary Care program was established by the Disadvantaged Minority Health Improvement Act of 1990. Passage of the Health Centers Consolidation Act of 1996 brought authority for all four primary care programs (community, migrant, homeless, and public housing) under section 330 of the PHS Act.

In its 4 decades of existence, the national network of health centers has grown substantially—and so has the range of services offered. Today, more than 1,000 health centers operate 6,000 service delivery sites in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. Besides primary health care, most of those sites now offer access to oral health, mental health, substance abuse services, and pharmacy services. Slightly more than half of all health center grantees—52 percent—serve rural America; the remainder are found in urban areas.

The last 6 years have been a period of unprecedented growth in the health center system. This expansion was accomplished through President Bush's Health Center Growth initiative. Approved by the President in 2001, and supported by Congress, the initiative's goal was to support 1,200 new or expanded health center sites across the Nation. Since 2000, Federal investments in the health center program have nearly doubled, from a little more than $1 billion in 2000 to more than $2 billion today, the largest funding increase in the program's history.

In 2007, health centers provided "health homes" to more than 16 million patients at an average cost per patient of $559. The 63 million patient encounters that health centers totaled that year were paid for from a variety of sources. The grants health centers receive from the Health Resources and Services Administration—an agency of the U.S. Department of Health and Human Services that oversees the health center network—amount to only about a fifth of an average health center's budget. Other financial support for health centers comes from Medicare, Medicaid, the State Children's Health Insurance Program, other government programs, patients' payments, and independent sources such as foundations.

What is a Health Home?

A “health” or “medical” home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. According to the American Academy of Pediatrics, a medical home is defined as primary care that is:

  • Accessible
  • Continuous
  • Comprehensive
  • Family centered
  • Coordinated
  • Compassionate
  • Culturally effective 3

Academic researchers have highlighted health centers' success in increasing access to care, improving health outcomes for patients, reducing health disparities among U.S. population groups, and containing health care costs. The World Health Organization recognizes health centers as a model of primary care delivery and has encouraged its replication and expansion in industrialized and developing nations.4

Bureau of Primary Health Care's Mission

Improve the health of the Nation's underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services.

next page > Critical Connections: Health Centers, America's Health Care Home

Smiling health center dental patient
Health Center Program Fundamentals
  • Located in or serve a high need community designated as a medically underserved area or population.
  • Governed by a community board composed of a majority (51 percent or more) of health center patients who represent the population served.
  • Provide comprehensive primary health care services as well as supportive services (education, translation, and transportation, etc.) that promote access to health care.
  • Provide services available to all with fees adjusted based on ability to pay.
  • Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.