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
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:
- Family centered
- 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
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
- Meet other performance and accountability requirements regarding
administrative, clinical, and financial operations.