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Access to Care and the Economic Impact of Community Health Centers. National Congress on the Un and Underinsured Monday, December 10, 2007 3:30 - 4:30 . The Robert Graham Center. Community Health Centers. What are health centers? Whom do they serve?
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Access to Care and the Economic Impact of Community Health Centers National Congress on the Un and Underinsured Monday, December 10, 2007 3:30 - 4:30 The Robert Graham Center
Community Health Centers • What are health centers? • Whom do they serve? • How do health centers overcome barriers to care? • How do health centers make a difference? • Why is investing in health centers important?
Health Centers: History and Purpose • Founded in 1965, through civil rights & war on poverty movements to address needs of poor & minorities • Two-fold purpose – • Be Agents of Care in areas with too little of same • Be Agents of Change, giving communities a role • Today: 1150 Health Center organizations • Located in every state and territory • More than 6,300 health care delivery sites, 600 of them school-based, plus additional mobile clinic, shelter, and labor camp sites
Health Centers Today • Health care home for over 17 million Americans • 1 of 5 Low-income Uninsured Persons • 1 of 8 Medicaid/CHIP Recipients • 1 of 4 Low-Income, Minority Individuals • 1 of 5 Low-Income, Uninsured Individuals • 1 of 9 Rural Americans • 923,400 Farmworkers, 940,000 Homeless Persons
Overcoming Barriers to Care • Key features of health centers: • Location in high-need areas • Open to everyone regardless of ability to pay • Offer comprehensivehealth and related services (especially ‘enabling’ services) • Tailor services to meet specific community needs (HIV, mental health, linguistic/cultural appropriateness) • Governed by community boards,to assure responsiveness to local needs
How Health Centers Make a Difference • Independent evaluations of centers find: • Excellent Quality of Care: More Effective Care, Better Use of Preventive Care, Fewer Infant Deaths • Major Impact on Minority Health: Significant Reductions in Disparities for Health Outcomes, Receipt of Preventive and Condition-Related Care • Higher Cost-Effectiveness: Lower Overall Costs, Lower Specialty Referrals and Hospital Admissions, Substantial Medicaid Savings • Significant Community Impact: Employment and Economic Effects, Contribution to Community Well-Being, Development of Community Leaders
The Access for All America Plan • Grow health centers program to serve 30 million people by 2015 by – • Developing new CHC sites and expanding existing sites • Funding every health center for oral and mental health, and for pharmacy services • Increasing workforce training programs (especially NHSC) to build primary care workforce for all • Increasing support for new facilities, equipment, HIT, and quality/performance improvement • Maintaining Medicaid and SCHIP coverage, and expanding it wherever possible
Who and How Many Need Care • Americans of all income levels, race and ethnicity, and insurance status have inadequate access to a primary care physician • 56 million Americas are “medically disenfranchised”
No Usual Source of Care • Nearly 1 in 5 (19.3%) Americans (55.5 million people) reported lacking a Usual Source of Care –same as our medically disenfranchised number; • Of those without a USC, 32% are uninsured and 21% are low income; • 52% of all uninsured people under 65 years of age have no USC; • Nearly a quarter (24%) of all poor or near-poor are without a USC; and • 32% of all Hispanic or Latino Americans have no USC • 23% of all Black,non-Hispanic people have no USC Source: 2004 Medical Expenditure Panel Survey
Map 1 Percent of Medically Disenfranchised By State, 2005 DE DC 40% or greater 20 - 39.9% 19.9 -10% Less than 9.9% National Average = 19.4% Note: Does not subtract health center patients as state and U.S. medically disenfranchised figures do. Source: The Robert Graham Center. Health Services and Resource Administration (HPSA, MUA/MUP data, 2005 Uniform Data System), 2006 AMA Masterfile, Census Bureau 2005 population estimates, NACHC 2006 survey of non-federally funded health centers.
No State is Immune • 21 States each have more than one million medically disenfranchised residents. • Florida, Texas, and California together make up 29% of the 56 million • 2 in 5 residents in nine states have threatened or limited access to basic health care. • 55.9% of Alabama residents are medically disenfranchised.
The Primary Care Payoff • American currently spends $2 trillion health care. • Health centers generate substantial savings • Americans could potentially save the health care system $67 billion.
CHCs and Hospitalizations • Average annual cost reduction of $1,810 (median reduction ($959) = 41% reduction • Average annual cost reduction for Medicaid $996 (median reduction $399) Source: 2004 Medical Expenditure Panel Survey
CHCs and ED visits • For Medicaid beneficiaries, 35.5% relative reduction in ED visits • 37% reduction for Blacks • CHCs may facilitate more appropriate ED use for uninsured and poor Source: 2004 Medical Expenditure Panel Survey
Health Center Savings • Health Centers generate between $9.9 and $17.6 billion. • By 2015, health centers would generate at least $22.6 billion, and as much as $40.4 billion.
Health Center Economic Benefits • Impact on predominantly low-income communities served: • Health center spending that flows to/through communities • Employment of local residents • Businesses in community that benefit from health center’s presence (directly and indirectly)
Methods • IMPLAN (Impact analysis for PLANning) – complete economic planning tool. • IMPLAN’s output, earnings, and employment figures are aggregated based on the following: • Direct effects • Indirect effects • Induced effects
Table 1Total Economic Activity Stimulated by Federally-Funded Community Health Centers’ Operations, 2005
Table 2Total Economic Activity Stimulated by an Average Large Urban and Small Rural Health Center, 2005
Future Impact • Federally qualified health centers could serve 30 million patients by 2015. • The estimated operating expenditures is $23.5 billion. • Projected expenditures - an estimated total economic impact of $40.7 billion. • Creating more than 460,000 full time equivalent jobs in 2015.
Challenges Ahead • Expansion • Investment • Workforce
For More Information Contact: Dan Hawkins dhawkins@nachc.com Bob Phillips bphillips@aafp.org Falayi Adu fadu@caplink.org View Both Access Denied and Access Granted at: www.nachc.com/research