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National Healthcare Disparities Report, 2004

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Focus on Federally Supported Health Centers

Community health centers serve a disproportionate share of the Nation's poor, uninsured, and racial/ethnic minorities and exist in areas where economic, geographic, and/or cultural barriers limit access to care. These centers are authorized under the Health Centers Consolidated Care Act of 1996, which amended section 330 of the Public Health Service Act and is administered by the Health Resources and Services Administration. Within the Consolidated Health Center program, there are several types of health centers that focus on providing care to specific vulnerable populations. HRSA awards grants to community health centers under section 330(e) to increase access to comprehensive primary and preventive health care and improve the health status of underserved and vulnerable populations throughout the United States and its territories. Health centers may also receive funding to provide services to special populations including homeless individuals, migrant and seasonal farm workers, and individuals residing in public housing, through individual health center grant mechanisms authorized under sections 330(g), 330(h), and 330(i), respectively.

In 2002, 843 HRSA-funded health centers reported delivering primary and preventive care to 11.3 million patients at some 3,400 service sites under the authority of section 330 of the Public Health Service Act. Eighty-eight percent of these health centers (N=743) received section 330(e) funding and 9.9 million people were served through this CHC funding. Sixty-four percent of individuals receiving care through these community health centers (N=6.4 million) had incomes below 100% of the Federal poverty level, 33% were uninsured, 50% had public insurance, and 62% belonged to a racial or ethnic minority group. Thus, community health centers are a critical source of care for low income individuals and racial/ethnic minorities.

The Presidential Initiative to expand health centers will create 1,200 new or expanded health centers by the year 2006, resulting in the provision of comprehensive primary and preventive care to a projected additional 6 million people, many of whom face multiple barriers to receiving health care. As health centers expand, they will also continue to generate knowledge on improving primary and preventive care delivery at the practice and system levels among underserved populations. Such information has the potential to achieve improvements in access to and quality of care for racial/ethnic minorities and the poor.

This NHDR focuses on care provided by these CHCs with data from the 2002 HRSA Community Health Center User Survey. This survey is sponsored by HRSA and provides nationally representative data about the users of health centers receiving section 330(e) funding and the services they utilize. A total of 2,129 completed interviews were conducted from eligible users in 70 selected grantees to provide estimates for over 6 million CHC users (N=6,115,098). Representative data from health centers funded under section 330 to provide services for special populations are collected via distinct surveys.

Quality of health care. Screening for cancer is an important element of preventive care in the adult population and a critical service provided by community health centers.

Figure 4.8. Women 40 and older in community health centers who reported having a mammogram in the past 2 years by race, ethnicity, and education, 2002

Figure 4.8. Women 40 and older in community health centers who reported having a mammogram in the past 2 years by race, ethnicity, and education, 2002. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: HRSA Community Health Center User Survey, 2002.

Reference population: Women 40 and older who receive care in community health centers.

Figure 4.9. People 50 and older in community health centers who reported having a sigmoidoscopy in the past 3 years by race, ethnicity, and education, 2002

Figure 4.9. People 50 and older in community health centers who reported having a sigmoidoscopy in the past 3 years by race, ethnicity, and education, 2002. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: HRSA Community Health Center User Survey, 2002.

Reference population: People 50 and older who receive care in community health centers.

  • In 2000, 70% of women 40 and older had a mammogram in the past 2 years, and many minorities and people of low SES were less likely to report screening (NHIS, 2000). In 2002, 70% of women 40 and older receiving care in CHCs had a mammogram in the past 2 years (Figure 4.8). Racial, ethnic, and SES differences observed in the general population were not observed among women in CHCs.
  • In 2000, 39% of persons 50 and older reported ever having a sigmoidoscopy, and many minorities and people of low SES were less likely to report screening (NHIS, 2000). By comparison, 37% of people 50 and older receiving care in CHCs had a sigmoidoscopy in the past 3 yearsiii (Figure 4.9). Proportions were similar among all racial, ethnic, and education groups.

Access to health care. An important element of access to care is having a usual source of care. Community health centers are the usual source of care for many low income and minority individuals.

Figure 4.10. People in community health centers who have a usual source of care by race, ethnicity, and education, 2002

Figure 4.10. People in community health centers who have a usual source of care by race, ethnicity, and education, 2002. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: HRSA Community Health Center User Survey, 2002.

Reference population: People who receive care in community health centers.

  • In 2001, 88% of the civilian noninstitutionalized population reported a source of ongoing care. Many racial and ethnic minorities and persons of lower SES were less likely to report such a source of care (NHIS, 2001). By comparison, in 2002, 98% of people receiving care in HRSA-funded community health centers reported a usual source of care. Proportions were similar among all racial and ethnic groups (Figure 4.10).

These data provide empiric evidence that HRSA-funded community health centers are successful in fulfilling their mission to improve access to care for millions of Americans and provide quality care to the patients they serve, regardless of race/ethnicity or socioeconomic status. Furthermore, racial/ethnic minority groups of users met or exceeded the Healthy People 2010 objectives for receiving mammography (70%) and for having a usual source of care (90%). These accomplishments may reflect health centers' longstanding community-oriented strategy of delivering health care and their participation in quality improvement initiatives such as the Health Disparities Collaboratives.


iii Note that the Community Health Center User Survey asks about sigmoidoscopy in the past 3 years while the NHIS asks about ever having sigmoidoscopy. Hence, it should be expected that the CHC rate would be lower than the NHIS rate.


 

 

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