Community health centers in the United States
This policy creates interesting implications in terms of how "participatory" CHCs are, as governing board members become directly invested in the quality of the clinic.
According to historian John Duffy, the concept of community health centers in the United States can be traced to infant milk stations in New York City in 1901.
In November, 1914, the city established the first district health center in New York at 206 Madison Avenue, serving 35,000 residents of Manhattan's lower east side.
The staff consisted of one medical inspector and three nurses stationed permanently in the district who, through a house card system, developed a complete health record of each family.
The Office of Economic Opportunity (OEO) established what was initially called "neighborhood health centers" as a War on Poverty demonstration program.
[7][8][9] Geiger had previously studied the first community health centers and the principles of community-oriented primary care with Sidney Kark[10] and colleagues while serving as a medical student in rural Natal, South Africa.
With increasing federal involvement and funding from programs like the OEO, the model of community health centers began to take shape, providing critical care to low-income populations.
[20] The evolution of the terminology used to describe what are now called "community health centers" is crucial to understanding their history and how they are contextualized in the United States social safety net.
To qualify as FQHC, CHCs receive cost-related reimbursement rates from Medicare or Medicaid, operate as a non-profit, and require a patient-majority community board.
[23] Characteristics linked to serious health problems, such as smoking and obesity rates, are also significantly higher in adult CHC patients compared to the general population.
Part of this problem lays in the foundations of immigrant communities, as many non-Western cultures perceive a strong stigma towards mental health topics and lack a proper system of social support to address these issues.
[33] Policies like the Affordable Care Act (ACA) and Chapter 58 have incrementally increased accessibility to healthcare, simultaneously setting a precedent for even further expansion.
Many Asian Americans, though a very diverse group, have historically felt discouraged from seeking help for mental health concerns due to stigma and pressure to focus on academic and professional success.
In doing so, Asian Health Services hoped to address the issue of pedestrian safety by simultaneously working on a long-term solution for increased quality of life.
This foundation is particularly important for cancer-focused navigation programs, which rely on Medicaid and similar resources to help patients overcome financial barriers to care.
Through these programs, CHCs not only facilitate access to cancer treatment but also provide essential support in navigating complex healthcare systems, ensuring that underserved patients receive comprehensive and timely care.
[46] These challenges are compounded by structural barriers like insufficient funding, low reimbursement rates for navigators and lack of integration within broader healthcare policies.
[46] Addressing these ongoing challenges requires a commitment to equitable resource distribution, improved technology integration, and policy reforms that prioritize underserved populations.
[50] Quality of care at CHCs can be assessed through many measurements and indices, including the availability of preventative services, treatment and management of chronic diseases, other health outcomes, cost effectiveness, and patient satisfaction.
[55] It is crucial for CHCs to evaluate the quality of care they provide in order to meet federal requirements and to fulfill their mission of eliminating health disparities based on socio-economic and insurance status.
Although 330 grants remain important to the financial viability of health centers, federal reimbursement policy under Medicaid has become their largest source of revenue.
The resulting payment structure reimbursed health centers on the basis of their actual costs for providing care, not by a rate negotiated with the state Medicaid agency or set by Medicare.
Health centers largely lost money in their early experiences of contracting and assuming risk for Medicaid managed care patients.
[65] In addition, to address a shortage of family physicians in CHCs, the act also increased funding for HRSA's Teaching Health Centers Graduate Medical Education (THC-GME) programs, which provides residency training in community-based primary care settings, rather than hospitals.
[67] Biden’s proposed budget supports the expansion of community health center funding and House Lower Costs, More Transparency Act (H.R.
They rapidly assembled curbside and drive-through swab testing, adapted facilities to ensure social distancing and increased integration of telemedicine.
Community health centers have no choice but to serve the safety-net populations most at risk, yet as a result, their revenue assets greatly declined with an estimation of $4 billion spent in eight months.
[68] In August 2020, Congress ended with no consensus on a new relief bill, demonstrating the continual push and pull of allocating sustained, long-term funding to community health centers.
[68] These federal investments further demonstrated the gaps in care without proper funding, as well as the necessity for community health centers’ capacity, adaptability and quality of medical and social support.
[69] The COVID-19 crisis, low Medicaid reimbursement rates and stagnant federal funding have forced community health centers to operate on thin ice.
