Community Health Centers – A Historical Look
These clinics are manned by nurses and general practitioners serving the people. The basic services provided by community health centers include dental care and family practice; and some centers even include other services such as pediatric, optometry, women’s care, lab, pharmacy, family planning, internal medicine and much more. These health care centers are basically patient- directed clinics built mainly for the masses with restricted access to medical care. Clients may include people with low- income or those who are underinsured, uninsured, or homeless.
The History Of Community Health – Where It All Began
The Beginning – Early 1900s
The historian John Duffy explains that the concept of community health care and community health care centers can be traced back to 1901; when milk stations for infants in the New York City were established as the first step for the health of the public. In November of 1914, New York City witnessed the establishment of the city’s first district health care center at 206 Madison Avenue. Back then it catered to 35,000 people of the lower east side of Manhattan. That health center was run by a medical inspector along with three nurses. It was run on a card system and a full health record of all the families in the district was monitored by the staff. By 1915 this idea expanded to Queens where four such district centers were established. This was the time of World War I and because of the war and politics, by 1916 this development came to an end and paved way for the privately funded health clinics that aimed to improve the condition and health of the poor. Many centers such as Bowling Green, Columbus Hill, Mulberry Street, and the Judson came up on different streets, and the Judson Health Center – established by Eleanor A. Campbell in 1921 – became the biggest health center of the U.S by 1924.
The 1960s – A Time Of Change
The 1960s witnessed the civil rights movement by civil rights activists of low-income earning communities. People realized the importance of community health care and this led to the official institution of community health care centers. Thousands of Americans, dwelling in suburbs and rural areas, suffering from major poverty and bad health, desperately needed health assistance. A civil activist who was also a doctor, H. Jack Geiger, came forward and was determined to serve people and change the scenario of health. As he completed his studies in South Africa, he found out the wondrous impact of the community health model on the health of Zulus who were devastated because of apartheid. With the announcement of President Johnson’s ‘War on Poverty’, the first proposal for a community health center – originally known as the ‘neighborhood health center projects – jumped up in the Office of Economic Opportunity (OEO). These clinics aimed to provide various points to access health and other social services for those who had poor access to them. This initiative focused on community empowerment. It was in December 1965 when the first modern community health center was established in Dorchester, Massachusetts – under the name, Columbia Point Health Center – by two faculty members and medical doctors, H. Jack Geiger of Harvard University and Count Gibson of Tufts University. As previously mentioned Geiger had studied principles of community health care and community-oriented primary care. Funding for two such neighborhood health center projects was approved in 1965; the Delta Health Care Center in Mound Bayou, Mississippi and the other one in Boston, Massachusetts. The federal funds for these clinics went directly to community-level, non-profit organizations. On the 25th anniversary of the clinic, in 1990, it was renamed the Geiger-Gibson Community Health Center and is still in operation today. Many idealistic men joined the war on poverty, such as Leon Kruger, who was the Director of CHC of Mound Bayou.
Although it was a risk, Congress passed newer sets of legislation which gave a new direction to health care in the country. The very first was an amendment to the Social Security Act in the year 1960 – which happened through the enactment of the Kerr-Mills measure – and endowed states with a subsidy for those who were medically impoverished. Two years hence, the Migrant Health Act was authorized in order to create rural health centers, after the plight of migrant farmers of America hit the national headlines. It was signed to provide migrant workers with health clinics as they traveled to harvest food for the country. However, the new era of healthcare was marked by the Economic Opportunity Act of 1964. It modeled America’s community health centers. It aimed to assist those who were at the ground level of poverty and combined the supplies of local groups with national funds to ascertain neighborhood clinics in rural, as well as urban, areas near America. It seemed like a foolproof formula which gave power to various communities and produced heavy evidence of accessible and affordable health care generating compounding profit. Due to the numerous studies conducted it was very evident that this type of health center standard could lower health disparity, reduce chronic disease, and lower the infant mortality rate. This model also generated jobs and various other investments in pressured communities and saved cost for the health care system because of the decreasing need for intensive care at emergency rooms in hospitals.
As stated in the preamble of the Economic Opportunity Act of 1964, the US holds it as the policy to eradicate the anomaly of poverty amid abundance by giving each of its citizens the opportunity of training and education, the opportunity of employment, and the chance to live with morality and self-esteem.
Medicare and Medicaid, which were legitimized in 1965, gave the necessary aids to the disabled, elderly, and families living below the poverty line. Early in the 1970s, the program of the Health Care Centers was shifted to the Department of Health, Education, and Welfare (HEW), which is now known as the Department of Health and Human Services (HHS).
The 1970s – Neighborhood Health
In 1975 ‘community and migrant health centers’ – otherwise known as ‘neighborhood health centers’ – were made permanent by Congress, which was later accompanied by primary health care programs for people inhabiting public housing, and the homeless.
The 1990s to Present
The Health Centers Consolidation Act of 1996 was passed in order to pool the two authorities. It was done under Section 330 of the Public Health Service Act (PHSA) in a bid to produce a consolidated health centers program. This health centers program is today known as Community, Migrant, Public Housing and Homeless Health Centers. This program is, at the moment, administered by The Health Resources and Services Administration (HRSA), and the Bureau of Primary Health Care (BPHC) under the U.S. Department of Health and Human Services (HHS).
The Patients of Community Health Centers
Community health centers are principally there to offer health care to those who are not insured or covered through Medicaid. By 2007 approximately 40% of CHC patients were short of insurance and 35% were patients of Medicaid. CHC patients have three times more chances of requesting care for chronic or serious conditions than patients who seek care from private suppliers. In comparison to the patients being treated by private physicians, CHC patients have a greater risk of coming across a referral obstacle, if patients with private insurance are excluded.
It was in the year 2008 that 1,080 CHCs gave primary health care to a population of more than 17.1 million people. CHC patients primarily live in low medical care communities with poor family income, typically have complex health conditions, and tend to dwell in rural areas.
Community Health Center Financing
The funding sources of the community health centers have changed with time. Section 330 of the Public Health Service Act was a major source of funds to community health centers. Even later it remained of major importance for funding, but the federal reimbursement policy of Medicaid became the biggest source of revenue.
Congress, in 1989, established the Federally Qualified Health Center (FQHC) program that asked for reimbursement for both Medicare and Medicaid. It became mandatory for all states to reimburse and cover all cost-related issues by the use of the Medicaid Payment System.
In the 1990s Medicaid shifted to a managed care delivery system, which required community health centers to change their structure of finance again.
The recession of the economy of the United States posed a major challenge to community health centers. President George W. Bush, in 2002, launched a Health Center Expansion Program that led to an increase in the access to basic health care services in about 1,200 communities by establishing new and bigger health center clinics. The Health Care Safety Net Act of 2008 gave the health centers program the expectation of extending the program by 50% over four years. By the year 2009 community health centers started receiving their funding through the American Recovery and Reinvestment Act (ARRA) and these health centers became available to a population of greater than 18 million people. By 2015 the community health centers were serving around 24,295,946 patients.
The service of community health care and community health centers is increasing with the passage of every day.
