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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

Critical Connections: Health Centers, America's Health Care Home

Whom do Health Centers Serve?

Health centers serve an increasingly diverse population from a variety of backgrounds and with a wide range of health needs.

People of all ages. 36 percent of patients in 2007 were children (age 19 and younger); about 7 percent were 65 or older.

Figure 1. Health Center Patients by Age Group, 2007*

Pie chart showing percentages of health center patients in five age groups in 2007.

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*Based on preliminary estimates

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2007.

People without and with health insurance.

Nearly 4 in 10 patients were without health insurance in 2007. While the proportion of uninsured patients of all ages has held steady at nearly 40 percent, the number of uninsured patients increased by 55 percent from 4 million in 2001 to over 6 million in 2007.

Table 1. Health Center Patients by Principal Third Party Insurance, 2007*

Percent and Number of Health Center Patients
Type of Third Party Insurance
Percent
Number
Uninsured
39%
6,205,660
Medicaid
35%
5,675,125
Medicare
8%
1,221,840
Other Public
3%
466,228
Private Insurance
16%
2,507,987

* Based on preliminary estimates Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2007.

People of all races and ethnicities. About two-thirds of health center patients are minorities. In 2006, 23 percent of health center patients were African-American and 36 percent were Hispanic/Latino - almost twice the proportion of African-Americans and over two and a half times the proportion of Hispanics/Latinos reported in the overall U.S. population.

Table 2. Trends in Percent of Patients by Racial/Ethnic Minority Status, U.S. versus Health Center Population, 2001 and 2006

 
Percent U.S. Population
Percent Health Center Program Population
 
2001
2006
2001
2006
Asian/Pacific Islander
4.0
4.5
3.4
3.5
Black/African-American
12.0
12.5
25.1
23.0
American Indian/American Native
0.8
0.8
1.0
1.1
Hispanic/Latino
13.0
14.8
34.8
36.1
White
69.8
67.4
35.7
36.3

Source: U.S. Census Bureau, Population Division. Table 3: Annual Estimates of the Population by Sex, Race, and Hispanic or Latino Origin for the United States: April 1, 2000 to July 1, 2006 (NC-EST2006-03) and Table 4: Estimates of the Population by Race and Hispanic or Latino Origin for the United States and States: July 1, 2006 (SC-EST2006-04). May 17, 2007. Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2001 and 2006. Note: 2006 data regarding race and ethnicity are used throughout this document due to a change in 2007 health center reporting of racial/ethnic identity. In 2007, an additional race category, "More than one race"and information about Latino / Hispanic identity were added. With the addition of this information, the UDS racial classifications are consistent with those used by the Census Bureau and the standards used to collect and present Federal data on race and ethnicity.

Special Populations. Some health centers also receive specific funding to focus on certain special populations including migrant and seasonal farmworkers, individuals and families experiencing homelessness, and those living in public housing.

Migrant Health Centers. In 2007, HRSA funded health centers served more than 826,000 migrant or seasonal farmworkers and their families. It is estimated that HRSA funded health center programs serve more than one quarter of all migrant and seasonal farmworkers in the United States. The Migrant Health Center program provides support to health centers to deliver comprehensive, high quality, culturally-competent preventive and primary health services to migrant and seasonal farmworkers and their families with a particular focus on the occupational health and safety needs of this population. Principal employment for both migrant and seasonal farmworkers must be in agriculture. Health Care for the Homeless Program. The Health Care for the Homeless Program is a major source of care for homeless persons in the United States, serving patients that live on the street, in shelters, or in transitional housing. In 2007, HRSA funded health centers served over one million persons experiencing homelessness. Health Care for the Homeless grantees recognize the complex needs of homeless persons and strive to provide a coordinated, comprehensive approach to health care including required substance abuse and mental health services.

Public Housing Primary Care Health Centers. The Public Housing Primary Care Program provides residents of public housing with increased access to comprehensive primary health care services through the direct provision of health promotion, disease prevention, and primary health care services. Services are provided on the premises of public housing developments or at other locations immediately accessible to residents. In 2007, HRSA funded health centers served over 133,000 residents of public housing.

Table 3. Trends in Health Center Program Special Population Patients, 2001-2007

  Number of Patients          
 
2001
2002
2003
2004
2005
2006
2007*
Migrant and Seasonal Farmworkers
686,166
708,611
694,040
726,813
776,668
807,153
826,639
Homeless
572,608
621,485
678,075
703,023
795,482
828,570
1,000,734
Public Housing Primary Care
70,026
93,642
110,266
106,322
122,113
129,280
133,404
* Based on preliminary estimates

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2001-2007.

How do Health Centers Serve their Patients?

Health Center Workforce

Increasing access and reducing disparities in health care requires quality providers who can deliver culturally-competent, accessible, and integrated care. Health centers recognize this need and support a multi-disciplinary workforce designed to treat the whole patient. In keeping with the growing demand for primary care, in 2007 health centers employed:

  • 8,000 physicians, a 40 percent increase from 2002.
  • Over 4,700 nurse practitioners, physician assistants, and certified nurse midwives - a 49 percent increase from 2002.
  • 50 percent of the National Health Service Corps field strength.

Figure 2. Average Number of Providers and Staff per Health Center: Growth, 2002-2007

Average Number of Providers and Staff per Health Center: Growth, 2002-2006

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Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2002-2007.

Health Centers Services

Health centers provide comprehensive services that must address the major health care needs of the target population and ensure the availability and accessibility of essential primary and preventive health services, including as appropriate, oral health, mental health, and substance abuse services.

Recognizing that barriers to care take various forms, health centers also include a variety of supportive and enabling services that promote access and quality of care such as translation/interpretation, case management, community outreach, nutrition, and transportation.

Table 4. Trends in Health Center Workforce by Provider Type, 2002-2007

  Number of Providers        
Type of Providers
2002
2003
2004
2005
2006
2007*
Medical
25,231
27,815
29,576
31,864
34,412
36,873
Dental
3,904
4,549
5,073
5,650
6,250
6,877
Mental Health
1,265
1,444
1,857
2,131
2,363
2,689
Substance Abuse
557
677
691
679
655
713
Other Professional
676
754
694
774
802
758
Pharmacy
1,179
1,409
1,634
1,820
2,025
2,182
Enabling Services
7,855
8,326
8,575
8,971
9,627
9,339
Other Programs and Services
1,570
2,280
2,398
2,603
2,691
2,862
Administration and Facility
27,720
30,842
33,191
35,715
38,615
41,295
Total Full-time Equivalents
69,956
78,096
83,688
90,206
97,440
103,588

* Based on preliminary estimates

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2002-2007.

Where are Health Centers Located?

Health centers provide high quality, culturally competent care to patients in every State, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. More than half (52 percent) of all health centers serve rural populations.

As the essential health care homes for some of the Nation's most vulnerable groups, they are delivering care where it is needed most.

National Impact: Health Centers as Critical Providers

Since the Health Center Program serves a much higher proportion of racial and ethnic minorities, individuals living in poverty and the uninsured than seen nationally - it is uniquely positioned to spread the benefits of community-based and patient centered care to these populations. The impact of the expansion of primary care through the Health Center Program is well-evidenced when looking at the national role of health centers reaching an estimated 20 percent of the 48 million underserved in areas lacking access to primary care providers. Looking at national numbers, health centers serve:8, 9

  • 1 in 20 individuals;
  • 1 in 12 African-Americans;
  • 1 in 9 Hispanic/Latinos;
  • 1 in 8 uninsured;
  • 1 in 7 individuals living below 200 percent of the Federal poverty level; and
  • 1 in 4 homeless individuals and migrant/seasonal farmworkers.

Table 5. Comparison of U.S. Population to Health Center Program Population: Uninsured, Poverty, and Racial/Ethnic Minority Status, 2006 Percentage of Population

  Percentage of Population
___________________
 
U.S. Population
Health Center Program Population
Ethnic / Racial Minority
33
64
Uninsured
16
40
At or Below 200 Percent of Poverty
31
92

Source: U.S. Census Bureau, Current Population Reports. Income, Poverty, and Health Insurance Coverage in the United States: 2006. August 2007. Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2006.

next page > The Health Center Model of Care

Health center patient being examined

What is
Primary Health Care?

Over 10 years ago, the Institute of Medicine convened a committee to discuss the future of primary care. They also established a definition of primary care — one that embodies the work that health centers have been doing for the past 40 years, and continue to do every day.

The committee defined primary care as:

The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

Most importantly, in the committee’s view, “no health care system can be complete without primary care, indeed it is the foundation of health care delivery.”5