Introduction
Community health centers refer to “Non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers” (Gusmano, Fairbrother & Park, 2002, p. 189). Community health centers are used to offer health services to underserved and uninsured people in the United States. According to research conducted in 2002, over a 50.7million Americans were uninsured. Moreover, many did not have access to proper healthcare. Hence, they depended on health providers who were either volunteer or bound to offer care to the less fortunate. Community health centers are managed by non-profit medical care providers who operate under broad federal standards (Gusmano et al., 2002). Two categories of clinics that meet community health centers’ standards are those that receive “Federal funding under section 330 of Public Health Services Act and the ones that meet all requirements applicable to federally-funded health centers and are supported by state and local grants” (Gusmano et al., 2002, p. 191). One of the unique features of community health centers is that 51% of their governing board members comprise patients who receive health services from the facilities. Additionally, patients are charged based on their income. These rules were established to guarantee that community health centers continue to offer quality and affordable services to society.
Community health centers are also called Federally Qualified Health Centers (FQHCs). They are mainly situated in high-need locations. The federal government establishes community health centers in poor areas and regions that record-high rate of infant mortality. Although CHCs are meant to serve the uninsured, they are open to all people (Gusmano et al., 2002). Even the insured access health services from community health centers. So as to meet the health requirements of all people, CHCs offer services tailored to the needs of the target population. Additionally, they provide services in an ethnically and linguistically appropriate way. Community health centers provide all-inclusive primary healthcare. Besides, they provide other services like translation, transportation, and case management, which facilitate service delivery. It is the duty of individuals working in CHCs to provide quality healthcare to bridge the gap in medical services between the insured and uninsured.
Mission and Functions
Community health centers are devoted to offering high-quality care to the United Sates’ underserved who comprise the minorities. Their mission is to provide healthcare to individuals who do not have access to quality medical services. They include seasonal farm workers, ethnic minorities and individuals residing in public housing. Community health centers have a mission to offer care to all individuals regardless of their financial status (Gusmano et al., 2002). They are dedicated to decreasing and even abolishing differences among their patients by offering affordable, quality and comprehensive care that is receptive and tailored to low-income, ethnic and marginalized societies.
Community health centers play numerous roles based on the needs of target population. One of the primary functions is to facilitate activities of the United States’ safety net healthcare system. The safety net encompasses people who are at risk of contracting diseases. Gusmano et al. (2002) assert that CHCs have been offering primary care to patients at no cost for over 45 years. Thus, their primary role is to provide medical services to vulnerable population living in rural and remote areas. Gusmano et al. (2002) maintain that CHCs are responsible for providing numerous enabling services like health education, language translation, parenting classes and childcare. Community health centers liaise with the public to improve living condition. They educate the public on health measures and how to maintain healthy environments. In addition, they offer parenting education and childcare services to mothers. Parenting education equips parents with requisite skills to enhance health of their children at an early age. They have helped to reduce the rate of infant mortality in the United States. Community health centers offer mother-child healthcare (MCH) services like immunization, tetanus inoculation and polio vaccination for young children (Gusmano et al., 2002).
Another role of community health centers is to offer counseling and support services. In some cases, individuals working in community health centers interact with patients who suffer from substance abuse and many forms of addiction. Such people visit the centers to seek assistance. Hence, health workers engage the patients in activities that help them to overcome addiction. Besides, they monitor the patients regularly to ensure that they do not experience relapses (Hunt, 2005). Community health centers work as both medical homes and care managers. They offer patient-centered, culturally necessary and lasting care. They represent not just physical location where patients access preventive and principal care, but also private relationship and a whole process of care. Community health centers focus on the whole person, not on a particular health problem (Hunt, 2005). They are controlled by a care management committee comprising medical professionals. The committee is formed by individual community health center based on its provider mix. Community health centers also assist patients to understand their circumstances and show them how to enhance their health.
Hunt (2005) alleges that community health centers have proved to be workable primary care models. As a result, the Government Accountability Office (GAO) has acknowledged CHCs for their fruitful and proficient delivery of health services. Community health centers have the potential to revolutionize delivery system since they work at the intersection of public health and medical care. They are responsible for offering preventive and screening services to patients who cannot access them. For instance, they offer pap smears and mammogram care to African American and Hispanic women who would not have access to these critical services due to financial hardship. Hunt (2005) posits “Community health centers meet or exceed national practice standards for chronic condition treatment” (p. 341). They offer a lot of experience concerning enhancing care for individuals with limited or no access to medical services. In fact, GAO have commended community health centers for their role in diagnosing, screening, and treating chronic illnesses like asthma, diabetes, cancer, cardiovascular disease and depression.
History
Origin of Community Health Centers
According to John Duffy, community health centers were first established in New York City in 1901. Later, the city started its first district health center that served over 35,000 patients. More community health centers were established in 1915. However, political demands and war led to an end of this expansion. The present community health centers owe their life to “A remarkable turn of events in U.S. history, and to a few determined community health and civil activists working in low-income communities during the 1960s” (Gusmano et al., 2002, p. 193). Millions of Americans residing in rural areas and inner-city environs across the country languished in abject poverty and were in dire need of health services. Jack Geiger was among individuals who led to the emergence of community health centers. He was a human rights campaigner and youthful doctor. Jack had studied in South Africa and amassed knowledge in how community health centers work. Hence, after going back to the United States, he felt the urge to establish community health centers to serve the underserved and uninsured population. His idea occurred at a time when President Johnson had declared war on poverty. Hence, the idea received massive support and by 1965, it received initial funding from the government (Gusmano et al., 2002).
The Congress helped in growth of community health centers by passing numerous laws. It amended the Social Security Act and directed the federal government to set aside funds to cater for the medically indigent. Two years later, the Congress passed the Migrant Health Act, which paved way for the establishment of medical facilities in rural areas to cater for migrant workers. However, it was the signing into law of the historical Economic Opportunity Act of 1964 that led to the conception of modern community health centers (Koh & Sebelius, 2010). The country developed community health centers that focused on the basis of poverty by pooling together federal and local community resources to establish medical facilities both in rural and urban areas. It was an approach that not only empowered society, but also demonstrated convincing testimony that reachable and inexpensive health care yield compounding benefits. Research proofed that community health centers lowered health disparities, chronic disease, and infant death. Besides, they created job opportunities for local people.
According to Koh and Sebelius (2010), ratification of Medicaid and Medicare laws in 1965 reinforced the formation of community health centers. The laws expanded the scope of CHCs to cater for the disabled, elderly and people living in abject poverty. In 1975, the Congress upgraded district health centers to serve as community health centers, which also served migrant workers. Later, it introduced programs that catered for people residing in public housing and street families. In 1996, the Congress consolidated all CHCs Acts under Public Health Service Act (PHSA). The consolidation helped to establish a comprehensive health centers program.
How the System was Formed
The United States federal government considered numerous factors before establishing community health centers. For a health facility to fall in community health centers’ system, it had to be located in regions where people have no access to health services. The federal government was responsible for identifying the underserved population. Establishment of CHCs came at a time when the government was determined to eradicate poverty (Koh & Sebelius, 2010). Community health centers were established based on the needs of individual communities. The primary objective was to reach vulnerable and underserved population. The federal government initiated the 330 grant program to split health centers’ grant in a way that would help each community health center to tailor its activities to patients’ demands.
Today, community health centers comprise an essential part of the United States’ health delivery program. It is the sole health care program that is managed in collaboration with patients (Draper, Hurley & Short, 2004). Each Federally-Qualified Health Center (FQHC) is governed by a community committee that comprises patients. The benefit of this system is that it gives patients an opportunity to decide on how to be served. Every community health center is obliged to institute a patient-majority management committee in order to obtain fund. The government believed that the only way it could serve marginalized communities is by giving them an opportunity to manage their health services. Besides, it was the only way to guarantee that community health centers stay reactive to community needs (Shi & Stevens, 2007). Forty years after their inception, community health centers are assisting people to meet increasing health needs and afford expensive and overwhelming health problems.
Impact of Community Health Centers on Healthcare System
Impact on Cost of Healthcare
Draper et al. (2004) allege that community health centers are comprehensive and affordable. They offer a myriad of medical services to a vast number of patients. They allege that CHCs disproportionately attends to a high number of chronically ill patients relative to other health facilities. Moreover, their average cost per patient is lower than for all other medical institutions. Draper et al. (2004) assert that study has shown that community health centers help to reduce healthcare costs. The study claims that CHCs’ adept provision of primary and protective care services eliminates needless, redundant and inefficient use of health resources. Community health centers help to reduce avoidable emergency department (ED) use and hospitalization. Besides, they avert the demand for costly specialty care services. According to Draper et al. (2004), individuals who visit community health centers have significantly lower expenditures per parson annually compared to those who visit other medical facilities. They allege that community health centers save the country over $24 billion yearly.
Many patients spend a considerable amount of money on emergency medical services. Draper et al. (2004) hold that community health centers reduce healthcare costs by preventing patients’ use of costly emergency medical services. Study shows that uninsured patients who access community health centers have little chances of seeking emergency medical services. Community health centers concentrate on deterrence and disease control. Hence, they protect the public from contracting illnesses that might require emergency services. Besides, they discourage patients from being hospitalized for conditions they can manage at home. For instance, CHCs encourage patients who suffer from asthma not to be admitted (Shi & Stevens, 2007). It helps patients to avoid incurring unnecessary admission costs. Latest research demonstrates that healthcare expenses for patients who visit community health centers are 44 percent lower than for those who use other medical facilities. It implies that community health centers not only help individuals to save on medical expenses, but also the federal government to save on its national healthcare costs.
Care given at community health centers is considered the most affordable. Shi and Stevens (2007) claim that on average, every person spends $600 on health yearly. Shi and Stevens (2007) charge “community health center per patient costs grow more slowly than national per capita health expenditure” (p. 160). They conclude that by the year 2015, an $11 billion investment in community health centers will save the United Sates at least $122 billion over the next five successive years.
Impact on Access to Healthcare
Access to health services is a primary public health issue. People associate access to health care with better services. Prior to the establishment of CHCs, many underserved and uninsured Americans had problems accessing medical services. While many Americans lacked health insurance cover, transportation also acted as a major barrier to access to healthcare (Cook et al., 2007). Majority of healthcare facilities were located in urban areas. Hence, people living in rural areas had to travel for long distances to access healthcare. It became difficult for many due to lack of money. Others who had money could not travel due to lack of means of transport. A study by Cook et al. (2007) found that at least 9% of the underserved population did not have access to healthcare due to transport problems. The group comprised the old, people living in rural areas and individuals who relied on public transport. In addition, transportation was cited a major hindrance to prenatal care services. It was hard for parents to take their children to childhood preventative medical services. Nevertheless, establishment of community health centers solved transportation challenges.
Apart from medical services, CHCs offer services that facilitate healthcare. They include transportation and case management. Through the help of community health centers, it has become easy for the old to access healthcare. The centers offer transportation services where people are picked from home and taken back after treatment. Pregnant mothers can now access prenatal care, thanks to community health centers (Cook et al., 2007). Moreover, Latino and African American parents can now take their children for preventive medical services. In addition, many patients who forewent cancer therapies due to transportation problems can now access treatment without challenges. In North Carolina, many people were unable to access vital chronic care management. They relied on public transport and assistance from friends, which were hard to get.
Cook et al. (2007) stated that access to healthcare means more than just possessing an insurance card. It means more than having access to emergency rooms. According to Cook et al. (2007), access to healthcare means having a constant and dependable source of superior primary and protective healthcare. Prior to the establishment of community health centers, majority of the uninsured and ethnic minorities did not have access to quality healthcare. Apart from inadequate finance, there were no enough medical providers in rural areas. Cook et al. (2007) claimed that community health centers helped over 21 million people to access primary care. The centers have helped the United States to break down the numerous intricate barriers to healthcare that citizens often face. Today, CHCs offer efficient and quality health care to majority of the underserved population in the United States. Apart from providing quality health services, CHCs have reduced cases of emergency room visits among patients.
According to Draper et al. (2004), “Community health centers have a proven record of reaching people and communities most in need, delivering high-quality care, and saving the healthcare system $24 billion a year” (p. 159). Federal law requires patients to run community health centers. Hence, their services are tailored to the needs of patients in a particular region. Besides, the law requires CHCs to serve all patients regardless of their race and financial status. Initially, people were denied health services due to financial challenges (Shi & Stevens, 2007). Nonetheless, community health centers have alleviated this problem. Majority of the community health centers are situated in areas where healthcare is in high demand but scarce. Therefore, they have helped the United States government to deliver health services to areas where it could have been difficult. Majority of patients who prefer community health centers claim that they offer customized and affordable services (Hunt, 2005). Others argue that they prefer community health centers because they are one stop shop. It is easy for patients to access a range of services regularly and within one facility. Hunt (2005) admits that low-income families that access community health centers receive better services than those that seek health care services from other facilities.
Community health centers are likely to admit new patients relative to other primary care facilities (Hunt, 2005). Besides, they are likely to extend their working hours. In fact, many community health centers open during weekends and run until late in the evening. Hence, it is hard for an individual to visit a health center and fail to receive treatment. Community health centers go beyond the conventional scope to offer comprehensive preventive care services not provided by a majority of other primary care facilities. For instance, patients have access to mental health, dental care, pharmacy services and substance abuse treatment.
Impact on Quality of Healthcare
Adashi, Geiger and Fine (2010) claim that community health centers have over 50 years experience in offering quality healthcare to uninsured and underserved people. They allege that CHCs provide cost-effective, high-quality preventive care to people in the United States. Today, CHCs serve over 22 million patients. Research shows that community health centers provide quality health care services and reduce cases of patients using emergency departments. Demand for community health centers is expected to rise due to health reforms. As more people get insurance covers, demand for medical services will shoot. Therefore, there is a need for expansion of community health centers to accommodate more patients.
According to Adashi et al. (2010), people who consistently use community health centers “Receive care of equal or greater quality and cost significantly less than those who use other providers, such as hospital outpatient units or private physicians”. Patient Protection and Affordable Care Act (ACA) has paved way for cooperation between community health centers and health departments in the United States. Consequently, health authorities are assisting CHCs to improve the quality of viral hepatitis and HIV/AIDS care and prevention services. Besides, the Act has assisted CHCs to enhance the quality of public and clinical services leading to better health results. Adashi et al. (2010) allege that ACA has prompted innovation in community health centers. The Act has helped CHCs to discover novel prevention and treatment mechanisms, therefore, helping patients suffering from complex chronic diseases. Protection and Affordable Care Act has set aside fund to facilitate the establishment of more community health centers to serve clients. Besides, it has provided CHCs with electronic health records (EHRs). The records have improved the quality of health services since physicians can monitor patient’s performance without difficulties.
Currently, community health centers have invested in numerous public health infrastructure and services. The centers run disease surveillance, community-based programs and health education (Adashi et al., 2010). Moreover, they offer preventive services aimed at lowering the rate of HIV/AIDS transmission. Health education has not only helped to improve the quality of health services, but also behavioral change. According to Eisert, Mehler and Gabow (2008), community health centers have invested in chronic disease management. They allege that people who suffer from chronic illnesses like viral hepatitis require multiple supports, preventive and clinical services. Consequently, CHCs have converted their facilities to patient-centered medical homes, which serve each patient based on his or her conditions. In addition, they have expanded their services to reach people living with HIV/AIDs and those at risk of contracting the disease due to cultural and social conditions.
In many states across the United States, community health centers have exploited technology to boost the quality of their services. For instance, many health centers use Telehealth Remote Patient Monitoring (RPM) system to monitor and assist patients suffering from chronic diseases. Additionally, the system has enhanced interactions between physicians and patients, thus enabling doctors to detect opportunistic diseases before they occur (Adashi et al., 2010). Failure to identify opportunistic diseases leads to hospitalization of patients suffering from chronic illnesses. Opportunistic diseases weaken their immune system and make them spend many days in hospitals. Through RPM, community health centers have been able to promote self-care among patients, therefore, reducing cases of hospitalization.
Community health centers are bestowed the responsibility to reduce inequality in health services among medically underserved populations. They act both as care managers and medical homes. According to Eisert et al. (2008), CHCs have eliminated the gap in visual healthcare among the uninsured and underserved society. Eisert et al. (2008) allege “The CHC system of the United States provides the types of primary care services that are consistent with optometry’s scope of practice” (p. 769). Hence, they guarantee that the underserved population has access to broad eye and vision care services. Besides, they have improved visual health among the minority groups. Existing laws do not openly delineate optometry as a compulsory service. However, community health centers opt to offer certain types of eye services like pediatric vision screening to ensure that children do not suffer from eye problems. Moreover, CHCs offer services other that are not necessarily required as a means to improve health of their patients. For instance, individuals who visit community health centers have low chances of suffering from diabetes since the centers run diabetes management programs.
As mentioned earlier, community health centers work both as medical homes and health managers. As medical homes, they encourage close ties between patients and medical personnel. Consequently, CHCs concentrate on the whole patient, and not just a single healthcare problem. As a result, CHCs are managed by a team of medical specialists, which is appointed by individual community health center based on its needs. The group “Coordinate and discharge patients’ care across multiple medical, behavioral, social, and other services and providers” (Eisert et al., 2008, p. 771). They help patients to know their condition and assist them to change behavior as a way to boost the entire health. In community health centers, medical personnel are devoted to incessant quality enhancement. A number of studies show that community health centers offer quality health services at low cost relative to other health providers. For instance, they provide primary care services that save many people from heart diseases.
Eisert et al. (2008) allege that CHCs are more than medical homes. Many patients go to community health centers claim that the centers assign them to personal physicians. Moreover, they are contented with the quality of services offered at CHCs. One of the reasons patients are satisfied with healthcare provided at CHCs is that medical services are readily available and accessible. Many admit that they do not wait for long to see a physician (Eisert et al., 2008). Moreover, the centers offer customized services that meet the needs of varied customers. Many patients are delighted to meet doctors who speak their languages. Hence, they relate to the physicians and explain their conditions without difficulties. Community health centers use treatment approaches that bring together health educators, case managers, medical professionals and others to guarantee that patients access requisite specialty, investigative and infirmary care. Hence, they reduce chances of their patients using emergency departments or being admitted.
Community health centers embrace a culturally-sensitive practice that is not common in other medical facilities. The practice helps to boost the quality of health services offered by CHCs. For instance, expectant women who go to community health centers give birth to children with normal weight. Other medical facilities often report cases of low birth weight. Indeed, the United States Government Accountability Office acknowledge community health centers as the ideal facilities for serving expectant mothers and individuals suffering from chronic diseases (Eisert et al., 2008).
Today’s Status of Community Health Centers
The United States’ network of community health centers offers healthcare services to the underserved population and minority groups regardless of their capacity to pay for the services. Today, all CHCs are managed by a board that comprises of patient-majority. Thus, patients are responsible for designing treatment models used by community health centers. That underlines why CHCs are known to offer customized services. According to Forrest and Whelan (2014), community health centers use care delivery system necessary for an itinerant multicultural population. The system comprises “Outreach programs, community health workers, patient navigation systems, evening hours, and the low-literacy health education” (Forrest & Whelan, 2014, p. 2078). In most cases, community health centers deal with patients that are hard to monitor. For instance, they deal with migrant workers, who move from one location to another. Therefore, it is hard to keep a medical record for such patients. It could be one of the reasons some CHCs are unable to assist some patients suffering from diabetes and HIV/AIDS.
Previously, many community health centers did not have time and right resources to carry out research or come up with resourceful interventions. Hence, they relied on different national organizations that had experience in dealing with the underserved population and migrant workers. Nevertheless, today, many community health centers have adequate financial resources and skilled personnel to carry out research and establish resourceful interventions (Forrest & Whelan, 2014). Besides, they work to improve the quality of their services in partnership with national organizations. In Washington, D.C., community health centers work in collaboration with National Association of Community Health Centers to devise technical approaches. Moreover, CHCs are currently using the Internet and on-site technical assistance to help patients cope with health challenges. In spite of community health centers offering medical services to patients from all walks of life, they only serve a small fraction of the migrant population. Forrest and Whelan (2014) claim that less than 20% of migrant workers access community health centers. The rest have no access to health services, or they rely on private medical facilities that are expensive. Forrest and Whelan (2014) maintain that migrant workers are today faced with numerous blockades to healthcare that they experienced five decades ago. Apart from migrant workers, other underserved populations also continue grappling with multiple burdens. They are forced to look for alternative care services whenever they travel.
Despite the challenges, it is worth to note that community health centers have revolutionized health system in the United States. Never before has the country witnessed a medical system that allows patients to determine and control their care services. Presently, community health centers have given the public full control of their care services. According to Forrest and Whelan (2014), patients no longer rely on a healthcare system that imposes treatment methods on them. To facilitate this, CHCs have established health education program. The program equips patients with skills on how to manage their health. Moreover, CHCs have programs that guarantee standard and incessant primary care to patients. Community health centers have closed the gap that existed between insured and uninsured patients. Besides, they have established patient-centered preventive care to deal with chronic diseases.
There have been claims that Obamacare has exerted immense pressure on community health care centers. Increase in the number of people covered under Obamacare is straining financial resources allocated to community health centers. Majority of low-income earners, who have medical cover, bought insurance plans that do not cater for all forms of illnesses. Consequently, they are sometimes forced to go back into their pockets and pay for medical services. Community health centers are not supposed to turn back any patient. Hence, majority of low-income earners are turning to CHCs to save themselves the extra cost. At times, insurers fail to pay for services rendered forcing community health centers to write-off the expenses. Forrest and Whelan (2014) argue that the introduction of Obamacare led to many people purchasing insurance covers that they could afford. In the end, community health centers have been forced to subsidize their services shifting the cost to the centers. Instead of the Obamacare reducing the number of the uninsured in the country, it increased the number of underinsured patients, and transferred the burden to community health centers.
Enactment of Affordable Care Act came as a relief to the majority of community health center leaders. They believed that the Act would help the uninsured to secure medical covers. To their surprise, it only increased the cost that community health centers incur to deliver health services. The medical covers use sliding-scale fee technique. Forest and Whelan (2014) allege “The use of the sliding-scale fee due to the inability to pay required co-pays impacts the community health centers’ uncompensated care costs, which are not declining as rapidly as contemplated by some policymakers” (p. 2081). The pressure is being experienced even in states with Medicaid schemes that cater for people whose gross incomes exceed 138% of poverty. Presently, community health centers are forced to subsidize medical services for patients with both Medicaid and bronze plans. Additionally, majority of patients who own bronze plans visit CHCs and lie that they do not have medical cover. Hence, it is hard for community health centers to distinguish between insured and uninsured patients.
Community health centers continue to record a tremendous increase in the number of patients that depend on Medicare scheme. The scheme caters for the old and people suffering from chronic diseases. The number of the old and people with chronic diseases have increased over the last two decades. According to Taylor (2004), the number of patients under Medicare scheme has grown 13 folds over the past ten years. The growth in number of patients who depend on Medicare and revision of Medicare system to cover additional services has affected the quality of medical services that CHCs offer.
Taylor (2004) stated that community health centers face shortage in capital infrastructure. Besides, the existing infrastructure is in poor condition and requires renovation. Given the limited financial resources, it is hard for CHCs to procure modern infrastructure. Currently, they need over $10.5 billion for infrastructure development. According to Taylor (2004), there are shortages in care management and use of superior health information technology systems. The centers need to invest in technology to help in monitoring and treating migrant workers and individuals suffering from chronic diseases.
Taylor (2004) alleges “Community health centers stand as proven primary care model” (p. 36). The Institute of Medicine (IOM) appreciates CHCs for their ability to deliver quality and efficient primary care. Community health centers can now offer widespread health care services under one roof. For instance, they diagnose, screen and manage chronic conditions like asthma, cancer, diabetes, depression and heart conditions. Taylor (2004) maintains “Community health centers are an economic catalyst causing a ripple effect in their communities” (p. 41). Apart from using financial resources efficiently, CHCs have created job opportunities for many patients. Community health centers source their goods and services from local people. In 2014, CHCs saved the United States a total of $20 billion in terms of medical costs. Besides, they created over 190, 000 jobs for people living in poor neighborhoods. In 2015, community health centers are expected to generate over $50 billion and create at least 250,000 jobs (Forrest & Whelan, 2014).
Impacts of Affordable Care Act on Community Health Centers
Affordable Care Act or what is popularly known as ObamaCare is a federal law aimed at enhancing healthcare services in the United States. Foster (2010) holds that the law was enacted to improve the affordability and quality of medical insurance, reduce the number of uninsured and lower the cost of healthcare for public and the government. The law brought about insurance exchanges, financial support and mandates (Foster, 2010). According to Affordable Care Act, all insurance companies are supposed to accord equal services to patients regardless of their gender or pre-existing conditions. The law does not require all states to oblige to its guidelines. Hence, some states have opted not to implement it (Foster, 2010). Affordable Care Act has enabled many people to acquire health insurance cover. According to Forest and Whelan (2014), over 20 million Americans had a medical cover by June 2014. The number of uninsured has gone down significantly, not to mention reduction in medical cost for individuals eligible for subsidies. Affordable Care Act has had both negative and positive effects on community health centers.
For states that embraced ACA, the number of patients that benefit from premium and Medicaid is estimated to be 2.8 million. In these states, community health centers are expected to benefit from $2 billion in extra proceeds from Medicaid and payment by insurance companies. Over 90% of people who go to community health centers are poor. Consequently, CHCs are expected to benefit from insurance reforms, as previously witnessed in Massachusetts (Foster, 2010). It is hoped that more states will expand their Medicaid in near future. Currently, Affordable Care Act has enabled more than 127 community health centers to open new access points. Additionally, over 67 new centers have been established in different states. Indeed, Affordable Care Act has not only led to increase in number of patients that go to CHCs, but also the number of community health centers and access points. Community health centers have not been investing in capital development due to financial constraints (Foster, 2010). Nevertheless, the endorsement of ACA has enabled some CHCs to embark on capital development. In 2010, over 144 community health centers benefited from $1.5 billion meant for capital investment. The centers have already expanded their infrastructure allowing them to reach more patients. Affordable Care Act has also facilitated capacity building. After its enactment, major renovation and expansion programs started in more than 171 community health centers (Foster, 2010). The projects enhanced the capacity of CHCs to offer preventive and primary medical services to uninsured and underserved citizens.
Foster (2010) alleged that Affordable Care Act opened investment opportunities for community health centers. He stated that community health centers benefited from $11 billion set aside for their expansion. It is believed that the fund will enable CHCs to serve over 40 million underserved people by the end of the year 2015. In addition, the law encouraged the introduction of electronic medical records in community health centers. Foster (2010) argues that ACA was designed to facilitate CHCs to be innovative in service delivery. Today, community health centers have established “Accountable care organizations, patient-centered medical home demonstrations, and community-based collaborative care networks” (Foster, 2010, p. 45). These new arrangements are meant to boost the quality of medical services in community health centers.
Community health centers located in states that have not embrace Affordable Care Act face a myriad of challenges. It is hard for the centers to diversify their services. Besides, the CHCs cannot spend in health care systems that boost efficiency and quality. There are fears that these CHCs may no longer enjoy financial grants (Foster, 2010). The grant may be channeled to other uses such as insurance expansion. If this happens, it will be difficult for the CHCs to continue serving the uninsured and offering services that Medicaid covers. Many community health centers have already raised concern over financial pressure. They argue that Affordable Care Act denies them Medicaid reimbursement, which has been significant in offering primary care.
Affordable Care Act gives all states the liberty to alter the range of services covered by Medicaid. Additionally, it allows community health centers to request for waiver of certain benefit packages (Foster, 2010). However, CHCs hold that patients will continue to use the packages. They argue that there is likelihood that the packages will not be as flexible as they have always been, therefore, subjecting them to financial risks. Foster (2010) alleges “Affordable Care Act sets the minimum rules of coverage and requires the Secretary of Health and Human Services to name significant benefits that each community health center should offer” (p. 49). Therefore, if patients require services that are beyond what ACA covers, community health centers are forced to bear the cost.
Community health centers complain that Affordable Care Act requires them to assume new duties and risks. For instance, they state that the Act requires them to carry out community health needs evaluation after every three years and publish the results (Koh & Sebelius, 2010). In addition, ACA requires community health centers to devise plans to address the needs. Even though the evaluation helps CHCs to improve health services, they argue that the task is burdensome. Moreover, the law does not set aside funds to facilitate the exercise. The Affordable Care Act aims to improve the quality of health services. However, it is impossible for community health centers to meet the aims due to financial limitations (Foster, 2010). Community health centers are worried especially about the consequences of not meeting ACA’s requirements. The federal government warned that financial penalties will be imposed on CHCs that fail to meet health standards. Health centers feel that the law did not put into consideration the nature of patients that they handle. Some patients are readmitted to a hospital due to the nature of their illness. It does not mean that a hospital does not meet health standards.
Impact of Community Health Centers on Health Administrators
Health administrators are bestowed the responsibility to manage a range of activities necessary for fruitful and timely delivery of medical services. They plan, coordinate, organize and supervise activities within medical facilities such as community health centers (Landon et al., 2007). The increase in number of community health centers and patients that visit the facilities has impacted healthcare administrators. Community health centers have given healthcare administrators an opportunity to develop their medical skills. Community health centers have been expanding their services in an effort to meet all patients’ needs. For instance, they have introduced dental, mental and optical services, which were not there before. Besides, they are in the process of converting to medical homes (Landon et al., 2007). These transformations have come with novel operations giving health administrators an opportunity to learn new skills.
The dream of the United States government is to offer healthcare services to all people. Healthcare administrators have tried all means to realize the dream. Community health centers have assisted health administrators to reach in areas that had no health facilities in the past (Landon et al., 2007). Nevertheless, one of the major challenges that CHCs pose to health administrators is cultural barrier. For decades, healthcare administrators have not been able to offer quality services due to cultural and language barriers. Majority of people who go to community health centers are conscious of their cultural beliefs. It is hard for administrators to administer treatments that seem to contravene patient’s cultural practices. To be able to interact with patients, hospital administrators have been forced to learn and adopt their cultures. Today, many hospital administrators are obliged to learn other languages or hire local interpreters so as to communicate with patients (Landon et al., 2007).
Increase in demand for community health centers’ services and reduction in funding has led to a shift in hiring. Administrators no longer recruit doctors. Instead, they hire nurses. Additionally, many administrators have been forced to relocate to rural areas due high demand. Increase in demand and number of services in community health centers has augmented the workload of health administrators (Landon et al., 2007). Nowadays, hospital administrators stay at work until late hours in an effort to reduce the workload. In addition, the centers are opened during the weekends due to patients’ demand.
Conclusion
Community health centers are society-managed health facilities that eliminate universal challenges to care by assisting underserved and uninsured population who suffer from economic, physical and cultural barriers. In the United States, community health centers help to offer health services to poor and minority groups. Their mission is to provide healthcare to individuals who do not have access to quality medical services. They include seasonal farm workers, ethnic minorities and persons residing in public housing. Their aim is to offer healthcare to all people regardless of their financial status. Jack Geiger was among the individuals who led to formation of community health centers. He got the idea of community health centers from South Africa.
Study has shown that community health centers help to reduce healthcare costs. Their proficient provision of primary and protective care services eliminates needless, unnecessary and inefficient use of health resources. Additionally, they contribute to reducing avoidable emergency department utilization and hospitalization. Also, they mitigate the demand for costly specialty care services. Apart from medical services, community health centers offer others services that facilitate healthcare. They include transportation and case management. Through community health centers, it is easy for the old to access medical healthcare. Endorsement of Affordable Care Act had both active and adverse effects on community health centers. There is hope that CHCs will benefit from insurance reforms, as previously witnessed in Massachusetts. Expectations are high that more states will expand their Medicaid in near future. Presently, Affordable Care Act has enabled more than 127 community health centers to open new access points. Affordable Care Act has not only led to increasing in number of patients who visit CHCs, but also the number of community health centers and access points. The health centers are managed by a committee that comprises patient-majority. Patients are responsible for designing treatment models used by their community health centers. Therefore, CHCs are expected to continue to offer customized services. In the United States, health administrators rely on CHCs for service delivery. The centers assist medical officials to reach the underserved population in rural areas.
References
Adashi, E., Geiger, J., & Fine, M. (2010). Health care reform and primary care: The growing importance of the community health center. The New England Journal of Medicine, 362(3), 2047-2059.
Cook, N., Hicks, L., O’Malley, J., Keegan, T., Guadognoli, E., & Landon, B. (2007). Access to specialty care and medical services in community health centers. Health Affairs, 26(5), 1459-1468.
Draper, D., Hurley, R., & Short, A. (2004). Medicaid managed care: The last bastion of the HMO? Health Affairs, 23(2), 158-162.
Eisert, S., Mehler, P., & Gabow, P. (2008). Can America’s Urban Safety net systems be a solution to unequal treatment? Journal of Urban Health: Bulletin of the New York Academy of Medicine, 85(5), 766-778.
Forrest, C., & Whelan, E. (2014). Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospitals outpatient departments, and physicians’ offices. The Journal of the American Medical Association, 284(16), 2077-2083.
Foster, R. (2010). Estimated financial effects of the Patient Protection and Affordable Care Act as passed by the Senate on December 24, 2014. Maryland: Centers for Medicare & Medicaid Services.
Gusmano, M., Fairbrother, G., & Park, H. (2002). Exploring the limits of the safety net: Community health centers and care for the uninsured. Health Affairs, 21(6), 188-194.
Hunt, J. (2005). Community health centers’ impact on the political and economic environment: The Massachusetts example. Journal of Ambulatory Care Management, 28(4), 340-347.
Koh, H., & Sebelius, K. (2010). Promoting prevention through the Affordable Care Act. The New England Journal of Medicine, 363(1), 1296-1299.
Landon, B., Hicks, L., O’Malley, J., Lieu, T., Keegan, T., McNeil, B., & Guadagnoli, E. (2007). Improving the management of chronic disease at community health centers. The New England Journal of Medicine, 356(1), 921-934.
Shi, L., & Stevens, G. (2007). The role of community health centers in delivering primary care to the underserved. Journal of Ambulatory Care Management, 30(2), 159-170.
Taylor, J. (2004). The fundamentals of community health centers. Washington, DC: The George Washington University.