Primary care is the level of a health services system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care, regardless of where the care is delivered and who provides it. It is the means by which the two main goals of a health services system, optimization and equity of health status, are approached.
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Community health centers (CHCs) are private, nonprofit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved. Community health centers are authorized under Section 330 of the Public Health Service Act, 42 USC, 254b. Section 330 was revised in 1996 by the Consolidated Health Centers Act, which combined community health centers with migrant health centers, health care for the homeless, and public housing health care programs. Section 330 health centers receive grant funding from the federal government (about 26% of revenue) and reimbursement from Medicaid (35% of revenue). They are also supported by other federal grants, state and local grants or contracts, private grants, Medicare, private insurance, and patient fees.
Community health centers have a three-fold mission. First, CHCs aim to improve access to care for low income, underserved, and vulnerable populations. They are required to be located in medically underserved rural and urban areas; within those communities, they serve those with limited access to more mainstream health care. Second, CHCs provide a fully comprehensive range of primary care services, including "enabling" or support services. Third, true to their roots in the community activism of the 1960s, they involve the community in both the management and governance of the center.
In FY 1996, there were 685 federally funded CHCs, operating in 3,032 sites across the U.S. and serving over 8 million people. A large proportion of health center patients are children (42%) and women of childbearing ages (39%). CHCs also serve a high proportion of minorities: 33 percent of users are African American, 29 percent Hispanic, and 5 percent Asian or Pacific Islander.
A majority of health center patients are either uninsured (41%) or on Medicaid (33%). The rest are private paying (17%), on Medicare (8%), or have other forms of public insurance, such as state health insurance (8%). Fifty-nine percent of health care patients are below the poverty level, and another 20 percent are between 100-200 percent of poverty. Because of their lower socioeconomic status, many health center patients have pressing health care needs.
Community health centers are required by law to provide “primary health services," and "additional health services as necessary" to the residents of the area served by the center (otherwise known as the "catchment area"). "Primary health services" are defined as 1) health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology, 2) diagnostic laboratory and radiologic services, 3) preventive health services, 4) emergency medical services, and 5) pharmaceutical services. Additionally, health centers provide referrals to providers of substance abuse services, mental health services, patient case management services, enabling services such as transportation and language services, and patient education. When appropriate for the population, health centers also provide environmental health services and migrant/agricultural workers services.
†This definition describes community health centers that are supported by federal grants and financing. There are many other types of health centers operating in the U.S. health care system, which receive public or charity funding (e.g., "free clinics" or health centers affiliated with hospitals, etc.). With the growth in outpatient, community-based care, the number of health centers has grown. Unfortunately, we do not have systematic data on these other types of health centers.
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