Keep Hope Alive
Recently, we had another healthcare professional come in from a local community health center located in New Hampshire. With community health centers, their main mission is to provide services to anyone who comes into their facility regardless of their ability to pay. They offer services beyond what a typical primary care practice would provide; such as dental services, nutrition services, behavioral and mental health services. If someone is uninsured and/or lives below the Federal Poverty line; they are extremely flexible when it comes to payment. In those cases, they generate a special payment arrangement for them on a monthly basis to ensure their organization gets paid for their services, which lessens the burden on the patient in terms of being faced with high medical bills. What I found interesting about this particular facility was they provide transportation services for patients who live in extreme rural areas, so they can make it to their medical appointments with ease.
In the United States, over 55% of health centers are located in rural areas and 45% are located in urban areas. Health centers in expansion states served 40% more patients than those in non-expansion states, reported higher staffing ratios for oral and behavioral health care and were more likely to report increased capacity to provide services (Paradise, Rosenbaum, Markus, Sharac, Tran, Reynolds & Shin, 2017). In non-expansion states, they struggle with insufficient insurance reimbursement, insufficient grant funding, workforce recruitment and retention. As a result, their overall quality of care decreases and the patients- especially the most vulnerable- don't receive the appropriate care that they deserve. Community health centers are supposed to provide health care for the medically underserved and vulnerable communities, yet they still face challenges when it comes to providing appropriate levels of care- especially in non-expansion states.
Although community health centers represent the largest source of primary health care for medically underserved rural and urban communities, those situated in non-expansion states struggle with quality of care, rates of revenue and capacity. The community health center located in New Hampshire is able to maintain higher quality of care, workforce recruitment and retention due to the fact that New Hampshire expanded Medicaid, but non expansion states don't have that same luxury. In fact, half of all health center patients nationwide were covered by Medicaid, but those in Medicaid expansion states were more likely to be covered than those in non-expansion states- 55% compared to 34% (Paradise, Rosenbaum, Markus, Sharac, Tran, Reynolds & Shin, 2017). The ACA coverage expansion plays an important role for community health centers; as they protect health care in vulnerable communities, provide comprehensive primary care, case management and other services such as medical transportation.
In the United States, over 55% of health centers are located in rural areas and 45% are located in urban areas. Health centers in expansion states served 40% more patients than those in non-expansion states, reported higher staffing ratios for oral and behavioral health care and were more likely to report increased capacity to provide services (Paradise, Rosenbaum, Markus, Sharac, Tran, Reynolds & Shin, 2017). In non-expansion states, they struggle with insufficient insurance reimbursement, insufficient grant funding, workforce recruitment and retention. As a result, their overall quality of care decreases and the patients- especially the most vulnerable- don't receive the appropriate care that they deserve. Community health centers are supposed to provide health care for the medically underserved and vulnerable communities, yet they still face challenges when it comes to providing appropriate levels of care- especially in non-expansion states.
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| Source: Kaiser Family Foundation |
Although community health centers represent the largest source of primary health care for medically underserved rural and urban communities, those situated in non-expansion states struggle with quality of care, rates of revenue and capacity. The community health center located in New Hampshire is able to maintain higher quality of care, workforce recruitment and retention due to the fact that New Hampshire expanded Medicaid, but non expansion states don't have that same luxury. In fact, half of all health center patients nationwide were covered by Medicaid, but those in Medicaid expansion states were more likely to be covered than those in non-expansion states- 55% compared to 34% (Paradise, Rosenbaum, Markus, Sharac, Tran, Reynolds & Shin, 2017). The ACA coverage expansion plays an important role for community health centers; as they protect health care in vulnerable communities, provide comprehensive primary care, case management and other services such as medical transportation.
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| Source: Kaiser Family Foundation |
Furthermore, community health centers struggle with challenges when it comes to providing services in expansion and non-expansion states. It is clear that those with lower income and uninsured patients will receive a lower quality of care in non-expansion states due to the fact that they have difficulty retaining staff, providing essential services and obtaining funding. If the states expanded Medicaid eligibility, they could see even greater improvements in coverage and quality. In regards to the recent attempt to repeal the ACA, continuing to provide funding in community health centers will be crucial in order to meet the needs of their patient populations and their overall health.
Paradise, J., Rosenbaum, S., Markus, A., Sharac, J., Tran, C., Reynolds, D., & Shin, P. (18 January 2017). Community health centers: Recent growth and the role of the aca. Retrieved from
https://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/
There are certainly challenges with community health centers. Not only is the funding a difficult issue but there is a declining interest for medical students to become primary care physicians. First off, specialty services (think anesthesiologist, surgeons, cardiologist) receive higher annual compensations than primary care. Another issue is that with the baby boomers getting older, there is an increase in demand for primary care type services. Therefore, the shortage of primary care physicians will continue to be an issue unless somehow they receive enough incentives to make working in a community health center work it.
ReplyDeleteI agree, and the healthcare professional that came in had mentioned that they have difficulty with workforce retention since-as you said- there is a decline in interests to become a primary care physician. As the baby boomer generation ages, hopefully it will have an impact on the salaries of primary care physicians as the demand for them will increase.
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