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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*
[D]
*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
[D]
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
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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
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