Health centers get boost ...

... but some seek more private-public collaboration

News that President Barack Obama’s budget includes a nearly $300 million increase to expand services at community health centers received mixed reviews from the public health community last week.

As the National Association of Community Health Centers commended the president for the $2.4 billion set aside for health centers, a 13% increase over the 2010 appropriation level, other public health providers emphasized the need for greater collaboration between these private, not-for-profit facilities and public entities.

“Federally qualified health centers do not and never will provide enough care for every uninsured person in the country,” said Kim Barnhill, administrator of the health departments in Jefferson and Madison counties in Florida.“And there are a lot of counties that won’t qualify as a health-professional-shortage area, so they won’t qualify” to become federally qualified health centers, she added. “Why are we not looking at ways to work collaboratively?”

While Barnhill acknowledged that the concept of a federally qualified health center is a good one, she said the federal government should take a closer look at how it allocates federal tax dollars.

“FQHCs can’t be everywhere,” Barnhill said of federally qualified health centers, “and the federal government hasn’t determined that there are others providing access—and those are the local health departments.”

Meanwhile, the association that represents these nearly 1,250 centers said the funding will ensure that patients have access to high-quality, affordable health services.

“The increased investment called for in the president’s FY 2011 budget proposal will allow 126 new community health centers that received funding through the American Recovery and Reinvestment Act to continue to deliver care to the 1 million patients they began to serve immediately upon opening their doors,” Tom Van Coverden, president and CEO of the National Association of Community Health Centers, said in a written statement.

And a new report released last week in the journal Health Affairs supports Van Coverden’s comments. In a study that examined community health centers between 1996 and 2006, researchers found that increased investment from federal, state, local and private sources in these centers has led to an increase in services for patients, including mental health and substance-abuse treatment and counseling as well as increased staffing. Federal grant funding alone grew steadily from about $550 million in 1990 to $925 million in 1999 and $2 billion in 2007, the report said. HHS says that if approved by Congress, the extra money will allow the creation of 25 new health centers “in communities without access to a health center, and will facilitate the integration of behavioral health into the existing health centers’ primary-care system,” according to an HHS budget summary.

But as Barnhill sees it, the federal government is “shortsighted” in its view of community health centers, as county health departments provide services and work closely with other members of the community—but do not receive recognition for doing so. For example, disease management is one area in which Barnhill’s departments work closely with hospitals to help patients manage chronic diseases. The department also works with local planning departments and county coordinators on related issues, such as sidewalks, parks and safe streets.

As an example of how the federally qualified health centers should not be the only solution to treat the underserved, Barnhill cited a statistic in the Health Affairs report that said an additional $500,000 in federal grants translates into 540 more insured patients treated.

“We have a federally qualified health center in Greenville and they do a nice job of providing primary-care services for residents in that area,” Barnhill said. “The problem is that we’re in rural North Florida. A big barrier for our population is transportation. They could no sooner travel 15 miles to Greenville than they could travel to the moon.”

And another part of the report showed funding is still inadequate and staffing continues to be a challenge, said Cindy Phillips, senior adviser for community health at the National Association of County & City Health Officials. The same is true for local health departments, Phillips said. A November 2009 report from the NACCHO showed that local health departments lost 8,000 staff positions from January through June 2009, which is greater than the loss of 7,000 local health department jobs for all of 2008.

Phillips also stressed the importance of collaboration between these centers and public groups, even though she acknowledged there are often barriers because of competition for dollars and staffing. But both sides stand to gain much by learning from each other. For example, Phillips explained, federally qualified health centers have received funding for health information technology, while a core function of health departments is gathering data. “They can really work hand in hand,” Phillips said, “and the community will benefit from them working closely together.”

According to Florida’s Barnhill, if health reform is to work, there needs to be more collaboration with the use of federal and state funding.

“Some of the resources poured into the federally qualified health centers should be spread around,” maybe even to hospitals or state agencies,” Barnhill said. “To dump it all into one pot with little accountability is a big, black hole.”

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