As the nation's federally funded health centers mark their 40th anniversary and increase their reported number of people served to 13.1 million, the work presented in this special issue not only retells their history, but also dispels the myth that healthcare for poor people translates into poor healthcare. Health centers, expressly designed to serve the underserved and accommodate their special needs, record impressive results, despite their patients' higher rates of morbidity and greater risk for poor health.
This issue adds to the existing body of work that documents improvements in preventive service utilization, chronic disease management, and even health outcomes in health centers. Health center cancer screening rates-Papanicolaou tests, mammography, and clinical breast examinations-exceed those rates for comparable populations. Health center uninsured patients are far more likely to report that they have a regular and usual source of care than those uninsured who obtain care elsewhere. In addition, the African American low birth weight rate at health centers is nearly 25% lower than the national average, representing a 40% reduction in the seemingly intractable national disparity between African Americans and Whites.
Health centers are building on their legacy of providing comprehensive primary and preventive care to vulnerable populations by implementing innovative quality improvement strategies. Since 1998, the Health Resources and Services Administration has supported the participation of 639 federally funded health centers in Health Disparities Collaboratives, initially designed to improve the management of chronic diseases such as diabetes and to develop an evidence-based improvement model. As a result, nearly 200,000 diabetics in the health center patient registry have experienced nearly a 1 percentage point drop in their average glycohemoglobin rates, which translates into reduced sickness, disability, and death. The collaboratives have expanded to include prevention and screening that involve the entire health center population and all encounters. The ultimate quality improvement goal is to apply system change to the entire health center population and range of both chronic and acute conditions.
Medicaid represents roughly one third of health center patients and revenue, and the evidence presented in this issue suggests that Medicaid beneficiaries who obtain their care at health centers are less likely to be hospitalized or use emergency departments for preventable conditions than beneficiaries who obtain care elsewhere. Although only 10% of all Medicaid beneficiaries now receive their care in health centers, health center program expansion has the potential to save millions of dollars for the Medicaid program by shifting patients to an effective and efficient healthcare delivery system.
Recognizing health centers' effectiveness in improving access to healthcare, starting in Fiscal Year (FY) 2002 the Bush administration embarked on the President's Health Centers Initiative, a 5-year plan to create 1200 new or expanded health center sites and serve an additional 6.1 million people above the 10 million served in 2001. The program has exceeded its site-development goals in each of the first 3 years of the initiative and anticipates meeting its 3-year goal of serving an additional 3 million patients. The President's proposed FY 2006 budget places the program on target to meet its 5-year goals. In addition, the President has recently proposed an expansion of health centers to the nation's poorest counties. Expanding usual and regular quality care to the most disadvantaged by the end of the decade is likely to produce significant improvements in the nation's health. This issue could not be more timely as the nation nearly completes one Presidential initiative and embarks on another.
Elizabeth M. Duke PhD
Administrator, Health Resources and Services Administration US Department of Health and Human Services Washington, DC