NACHC report reveals disturbing divergence of supply and demand in primary care
WASHINGTON, DC—Demand for primary care has outpaced supply nationwide, leaving many communities with primary care providers who are absent, unaffordable or inaccessible because of distance, special healthcare needs, insurance status, or cultural barriers.
“People who cannot navigate these obstacles are forced to forego or delay seeking care, leaving them with many unmet healthcare needs,” said Dan Hawkins, senior vice president for policy and research at National Association of Community Health Centers (NACHC), who revealed the study, “Health Wanted: The State of Unmet Need for Primary Health Care in America,” on Capitol Hill as the cherry trees were budding in late March. The briefing coincided with the two-year anniversary of the historic passage of the Affordable Care Act (ACA).
The NACHC 2012 report demonstrated how Americans are turning to the national network of Community Health Centers (CHCs) in greater numbers, yet the need for their services continues to outpace growth.
Sip Mouden, CEO of Community Health Centers of Arkansas, one of three healthcare leaders who shared their program highlights at the briefing – the only one on a state level – and Region 6 representative on the NACHC Board of Directors, pointed out that CHCs, also known as Federally Qualified Health Centers (FQHCs), serve 40 million Americans and operate more than 8,000 healthcare delivery sites in all 50 states. These health centers provide one-quarter of primary care visits for the nation’s low-income population, comprising a substantial share of the nation’s primary care infrastructure.
“Every year, we update our plan of state growth strategies, and all of the elements, factors, and barriers to healthcare mentioned in the report are certainly ones that Arkansas is very familiar with,” said Mouden, noting that 555,000 Arkansans lack access to primary care. “The report is very meaningful to us, and reflects exactly what we’re seeing now.”
Nancy A. Sink, CEO of Family Health Care of Northwest Ohio, and Allen J. Bennett, CEO of Park West Health Systems Inc. in Baltimore, Md., represented two local health centers that identified their mission, accomplishments and community needs at the national event.
“Community Health Centers have expanded their services in recent years, thanks to federal investment and support,” said Hawkins. “Unfortunately, the circumstances may vary, but the outcome is almost always the same: when people fail to receive needed medical care, their health deteriorates.”
The number of Americans who forgo or delay needed care has nearly doubled in the past decade. The scarce options for primary care mean that people will delay or fail to receive primary care services, putting them at risk for poor health.
“This trend among the medically underserved is drastically inflating healthcare costs,” said Hawkins. “Many people turn to hospital emergency departments for non-urgent care; as many as 30 percent of visits to hospital ERs could be treated in a primary care setting. If everyone could access needed primary care services when they need them, the U.S. healthcare system could save $67 billion a year.”
CHCs have been hindered by federal budget reductions. Communities across the nation submitted nearly 2,000 health center grant applications; fewer than 10 percent received funding. In fiscal year 2011, only 67 of 810 new health service centers were funded. The Health Resources and Services Administration (HRSA), the federal agency that oversees the CHCs, had originally planned to fund 350 grants before funding was significantly reduced.
CHCs aren’t present in more than one-quarter of the counties with unfavorable primary care needs, including barriers to care of affordability, availability and accessibility; poor health outcomes; and economic consequences.
Two examples of new CHC applications that remain unfunded:
In Clark County, Nevada, population 2 million on the doorstep of Las Vegas, there are only two CHC grantees. A significant portion of Nevadans are uninsured because many of them work in places that don’t provide healthcare coverage, therefore overloading emergency rooms for routine care because they cannot pay cash for their healthcare needs.
In Hardin County, Ohio, which is federally designated as a Primary Medical Care Health Professional Shortage Area and a Dental Health Shortage Area, residents must drive more than half an hour to a neighboring county, a round trip of 66 miles, to access care even though nearly half the population doesn’t own their own car and escalating gas prices have taken a toll on the ability to pay for gas to drive to an appointment. Health Partners of Western Ohio Community Health Center, which operates two sites in nearby counties, applied for a new access point in Hardin County. It didn’t receive funding.
“We can work with patients before their illnesses are exacerbated into chronic diseases, require hospitalization and wind up costing more money,” said Mouden. “If they have a primary care medical home, we can help them get control of and manage chronic diseases, while also providing preventive care. We hope the federal government will take this report seriously and help us help the U.S. save money.”