Reform #3

Reform #3
Our third reform on outpatient and primary care will focus on increasing the number of community health centers (CHC). CHCs are not free clinics. They are community owned non-profit organizations which are funded by the Public Health Services Act. CHCs provide care to medically underserved areas and provide services for anyone needing care no matter their insurance status or their ability to pay. They provide primary care, preventive care and dental care in 3,650 sites across the United States. They follow a sliding fee schedule based on patient’s income and take direct or third party payments. CHCs improve access to preventive care and health status, provide high quality care and cost effective care, and reduce health disparities within the population. (Shi and Singh, 272)
The health disparities of the underserved population could be reduced with the growth of CHCs. CHCs have been shown to reducing the number of low birth weight babies and hospitalization for patients with chronic conditions, as well as increasing the amount of preventative women’s health services(Taylor). The addition of these clinics will not only increase the access to health care for the medically underserved population, but they will also increase the quality and access of emergency care.
Currently, emergency departments are overused for non-urgent and routine care; fewer than half the visits aren’t emergent conditions (Shi and Singh, 261). The Emergency Medicine Treatment and Active Labor Act (EMTALA) of 1986 is thought to be the key factor of this overuse. EMTALA requires all hospital emergency departments to see all patients and stabilize them if needed without considering their ability to pay. No other part of the healthcare system is required to accept everyone (Healthaffairs.org). Many people who don’t have insurance use emergency departments for their primary care because they can’t be turned away and most clinics won’t treat them. This results in crowding of the emergency departments, causing bed shortages, too few RN’s, and longer waiting periods. The improper use of the facilities and personnel increases the costs because the emergency departments were not set up to provide primary care (Shi and Singh, 272).
Adding more CHCs will allow the uninsured to received primary care without having to go the emergency department. Having fewer patients come into the emergency department will free up RNs and rooms. This will also shorten the waiting period for patients who are in need of emergency care and increase the quality of care given. The quality of care provided by emergency department will increase because the personnel won’t have as many patients to provide care for. The cost of the emergency departments will decrease because the inappropriate use of the equipment won’t be high as less patients use the emergency department for primary and routine care.
From 1988-2001 a study was done in Kansas looking at how CHCs effected care for uninsured patients and the effect on the local hospitals. This study found that within three years after the state started funding CHCs, the number of uninsured patients’ visits to the local hospital emergency departments decreased by around 40%. Ten years after the state funding started the number of uninsured patient visits to the emergency department are still 25% lower than prior to when the funding began. In that ten years the decreased visits of uninsured patients to the emergency department saved almost $14 million dollars (Smith-Campbell).
The use of more CHCs will provide compressive quality medical care for the underserved population in a cost effective manner. Over time, CHCs will not only increase the medically underserved access to quality healthcare but also everyone else’s. This will result from fewer patients using the emergency departments for primary care allowing the remaining patients to receive higher quality care.

References:
Delivering Health Care in America, Shi and Singh.
Healthaffairs.org: (http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.146v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=emergency+department&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT ).
Smith-Campbell, B. "Emergency department and community health center visits and costs in an uninsured population." Pubmed. 22 Mar. 2009 <http://www.ncbi.nlm.nih.gov/sites/entrez>.Taylor, Jess. "The Fundmentals of Community Health Centers." National Health Policy Forum (2004). 22 Mar. 2009 http://www.aoa.org/documents/Fundamentals-of-CHC.pdf