Nursing News:
New report examines the challenges that face the nations¹ community health centers: increased uninsured, Medicaid cuts, and crowed ERs

A growing uninsured patient population, tightening revenues, Medicaid cuts and a shortage of primary care physicians are posing a challenge to Community Migrant, Public Housing and Homeless Health Centers, according to a new report by the National Association of Community Health Centers (NACHC). The report, ³Nation¹s Health At Risk: Part II² examines health care trends from the health center perspective and offers up a snap shot of communities in need.
³As part of the first line of defense in the war against poverty and disease, health centers hold a unique Œfront row seat¹ to what¹s going on in health care,² said Dan Hawkins, Vice President for Policy at NACHC. ³Health center uninsured patients grew 11 percent in 2003 and now stands at almost six million patients. This report also documents dangerous trends‹such as Medicaid eligibility cutbacks and cuts in direct funding to health centers‹that are impacting access to affordable health care.²
The report is the second installment of a series that NACHC is producing to evaluate the state of the nation¹s health. It was issued at a news conference launching ³National Health Cen
ter Week 2004.² The event featured two speakers from health centers in urban New York and rural Virginia. ³What this report reveals are the very serious holes in our health care system that are getting bigger,² said Dr. Monica Sweeney, MD, Vice President of Medical Affairs, Bedford Stuyvesant Family Health Center in Brooklyn, NY. ³I see evidence of this every day at our health center, where uninsured patients are lining up at the door. Many of the patients I see waited longer than they should have before coming to see a doctor because they didn¹t have insurance or worried about how much the care would cost.²
A tightening revenue stream is also posing a challenge to rural health centers, which must balance limited resources and the demands of a growing patient population. ³Right now we are struggling,² said Nancy Stern, Chief Executive Officer of Eastern Shore Rural Health System, Inc. in rural Nassawadox, Virginia. ³We need primary care physicians and are trying to recruit more. We also need more exam rooms for patients but our buildings are very old, outdated, and in need of repair and renovations. There is no money to fix them, and the demand continues to grow. We added two thousand new patients last year.²
Among the highlights of the report:
€ More Uninsured People at America¹s Health Centers-- Some health centers are experiencing an explosion of uninsured patients as high as 73 percent, and no let-up is in sight. In fact, the fastest growing age group that health centers serve is 45-64 years‹the age group more at risk for being uninsured than ever before.
€ More People Are Using Emergency Rooms-- In 2002 there were 110.2 million visits to hospital emergency departments (ED)‹up from 89.8 million in 1998 (despite the fact that the number of hospital EDs in the U.S. fell by 15 percent during the same time period). Anywhere between 10 to 50 percent of all ED visits are for non-urgent and avoidable conditions, and the medically vulnerable are more likely to make such visits. If these same patients went to a community health center instead, between $1.6 and $8 billion in annual health care costs could be saved nationally.
€ Too Few Primary Care Doctors For Vulnerable Populations‹The number of primary care physicians per capita is shrinking, while the number of specialists has been rapidly growing. Fewer doctors open their doors to patients who rely on Medicaid. One-fifth are not accepting any new Medicaid patients.
€ Cuts In Direct Funding, Medicaid Challenge Health Centers‹States are balancing their budgets by cutting health care costs and Medicaid spending. Oregon, Mississippi, Texas, Georgia, Wisconsin, Arizona, Colorado, Connecticut, New Hampshire, Rhode Island, South Carolina, Vermont are doing so‹and other states are taking actions on Medicaid that could result in millions getting shut out of affordable health care.
For more information about health centers and National Health Center Week 2004, visit www.nachc.com.