Public and private investments in community health centers – institutions that provide care to approximately 15 million of the nation’s poor and medically underserved – have led to greatly expanded services and care for people who are uninsured, says a study published in the February 2010 edition of Health Affairs. Based on their study, the authors predict that a $500,000 increase in grant support for all centers would provide treatment for an additional 500,000 uninsured patients.
The authors say that these findings bode well for effective use of the more than $2 billion in funds provided to community health centers under the American Recovery and Reinvestment Act. The stimulus funding was the largest one-time investment in the centers in their history – and this study shows that in previous years, the centers used such investments to increase the care provided to low-income or underserved patients.
“Community health centers play a vital role in providing primary care and other services to those who cannot afford it or cannot access care. They are an investment that pays off for patients and the nation as a whole,” said lead author Anthony Lo Sasso, a researcher at the University of Illinois at Chicago School of Public Health. The work by Lo Sasso and colleagues was discussed in media outlets such as Reuters, Modern Heatlhcare, and NPR’s Marketplace.
Researchers examined effects on care of investments in 1996-2006 from federal, state and local or private sources to so-called federally qualified community health centers. These are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless that meet federal criteria for receiving funding. Federal grants to federally qualified community health centers, for example, have grown from roughly $550 million in 1990 to nearly $2 billion in 2007.
The study authors found that these and other public dollars helped increase virtually all services, especially mental health and substance abuse treatment and counseling.
Highlights of what these investments yielded are as follows:
• Expanded Mental Health Care. Federal grants helped increase mental health services in community health centers at a time when many psychiatric hospitals have closed. Each additional $1 million in federal grants increased the probability of centers offering round-the-clock, on-site mental health treatment and counseling services to patients.
• Increased Staffing. Increased grant support boosted staffing throughout community health centers. For example, the average number of physicians at centers increased from 5.5 in 1996 to 6.8 in 2001, while the average number of total full-time employees increased from 66.3 to 83.4. Each additional $1 million of federal grant support led to roughly eight more full-time employees, five of whom were medical care providers. Each additional $1 million in state grants led to close to five full-time employees, while private grant dollars led to nine new employees.
• Additional Centers. Public and private funds helped grow the number of community health centers from 729 in 1996 to more than 1,000 in 2006. The funding also allowed health centers to operate more sites so that they could serve more patients.
• Expanded Services. Federal and private investments allowed more health centers to provide on-site 24-hour services.
• Providing More Care. Public and private grants also led health centers to provide more free or discounted care to uninsured and underinsured patients. The average amount of free or discounted care that health centers provided increased from roughly $781,000 in 1996 to nearly $1.25 million in 2001.
The authors predict that an additional $500,000 in federal grants to federally qualified health clinics would help provide $135,000 worth of free or discounted care and could translate into 540 more uninsured patients who receive treatment. If federally qualified health centers leveraged their federal grant support to gain additional state, local, and private grant dollars, this could lead to higher levels of service and more care for the uninsured, the researchers conclude.