Access to Care and the Economic
Impact of Community Health
Centers
National Congress on the Un and Underinsured
Monday, December 10, 2007
3:30 - 4:30
The Robert
Graham Center
Community Health Centers

What are health centers?

Whom do they serve?

How do health centers overcome barriers to care?

How do health centers make a difference?

Why is investing in health centers important?
Health Centers: History and Purpose


Founded in 1965, through civil rights & war on
poverty movements to address needs of poor &
minorities
Two-fold purpose –
 Be
Agents of Care in areas with too little of same
 Be Agents of Change, giving communities a role

Today: 1150 Health Center organizations
 Located
in every state and territory
 More than 6,300 health care delivery sites, 600 of
them school-based, plus additional mobile clinic,
shelter, and labor camp sites
Health Centers Today

Health care home for over 17 million Americans
 1 of 5 Low-income Uninsured Persons
 1 of 8 Medicaid/CHIP Recipients
 1 of 4 Low-Income, Minority Individuals
 1 of 5 Low-Income, Uninsured Individuals
 1 of 9 Rural Americans
 923,400 Farmworkers, 940,000 Homeless Persons
Overcoming Barriers to Care
 Key features of health centers:
 Location in high-need areas
 Open to everyone regardless of ability to pay
 Offer comprehensive health and related services
(especially ‘enabling’ services)
 Tailor services to meet specific community needs (HIV,
mental health, linguistic/cultural appropriateness)
 Governed by community boards, to assure
responsiveness to local needs
How Health Centers Make a
Difference

Independent evaluations of centers find:

Excellent Quality of Care: More Effective Care, Better
Use of Preventive Care, Fewer Infant Deaths

Major Impact on Minority Health: Significant
Reductions in Disparities for Health Outcomes,
Receipt of Preventive and Condition-Related Care

Higher Cost-Effectiveness: Lower Overall Costs,
Lower Specialty Referrals and Hospital Admissions,
Substantial Medicaid Savings

Significant Community Impact: Employment and
Economic Effects, Contribution to Community WellBeing, Development of Community Leaders
The Access for All America Plan

Grow health centers program to serve 30 million
people by 2015 by –
 Developing
new CHC sites and expanding existing
sites
 Funding
every health center for oral and mental
health, and for pharmacy services
 Increasing
workforce training programs (especially
NHSC) to build primary care workforce for all
 Increasing
support for new facilities, equipment, HIT,
and quality/performance improvement
 Maintaining
Medicaid and SCHIP coverage, and
expanding it wherever possible
Who and How Many Need Care

Americans of all income levels, race and
ethnicity, and insurance status have
inadequate access to a primary care
physician

56 million Americas are “medically
disenfranchised”
No Usual Source of Care

Nearly 1 in 5 (19.3%) Americans (55.5 million
people) reported lacking a Usual Source of Care –
same as our medically disenfranchised number;

Of those without a USC, 32% are uninsured and
21% are low income;

52% of all uninsured people under 65 years of age
have no USC;

Nearly a quarter (24%) of all poor or near-poor are
without a USC; and

32% of all Hispanic or Latino Americans have no
USC

23% of all Black,non-Hispanic people have no USC
Source: 2004 Medical Expenditure Panel Survey
Map 1
Percent of Medically Disenfranchised By State, 2005
DE
DC
40% or greater
20 - 39.9%
19.9 -10%
Less than 9.9%
National Average = 19.4%
Note: Does not subtract health center patients as state and U.S. medically disenfranchised figures do.
Source: The Robert Graham Center. Health Services and Resource Administration (HPSA, MUA/MUP data, 2005 Uniform Data System), 2006
AMA Masterfile, Census Bureau 2005 population estimates, NACHC 2006 survey of non-federally funded health centers.
No State is Immune

21 States each have more than one million
medically disenfranchised residents.

Florida, Texas, and California together make
up 29% of the 56 million

2 in 5 residents in nine states have threatened
or limited access to basic health care.

55.9% of Alabama residents are medically
disenfranchised.
The Primary Care Payoff

American currently spends $2 trillion health
care.

Health centers generate substantial savings

Americans could potentially save the health
care system $67 billion.
CHCs and Hospitalizations

Average annual cost reduction of $1,810
(median reduction ($959) = 41% reduction

Average annual cost reduction for
Medicaid $996
(median reduction $399)
Source: 2004 Medical Expenditure Panel Survey
CHCs and ED visits

For Medicaid beneficiaries, 35.5% relative
reduction in ED visits

37% reduction for Blacks

CHCs may facilitate more appropriate ED
use for uninsured and poor
Source: 2004 Medical Expenditure Panel Survey
Health Center Savings

Health Centers generate between $9.9
and $17.6 billion.

By 2015, health centers would generate at
least $22.6 billion, and as much as $40.4
billion.
Health Center Economic Benefits

Impact on predominantly low-income
communities served:
 Health
center spending that flows to/through
communities
 Employment of local residents
 Businesses in community that benefit from
health center’s presence (directly and
indirectly)
Methods
IMPLAN (Impact analysis for PLANning) –
complete economic planning tool.
 IMPLAN’s output, earnings, and
employment figures are aggregated based
on the following:

 Direct
effects
 Indirect effects
 Induced effects
Table 1
Total Economic Activity Stimulated by Federally-Funded Community
Health Centers’ Operations, 2005
Total Economic Impact
Employment (Full Time Equivalents)
Direct
$7,261,975,096
89,922
Indirect
$1,124,387,922
10,233
Induced
$4,172,328,893
42,918
Total
$12,558,691,911
143,073
Note: Total Economic Impact includes Value-Added Impact. For an explanation, see Appendix B. Payroll (Value-Added),
estimated at 73% of Operating Expenditures, is based on Capital Link’s financial database Fiscal Year 2005 median
value for health centers nationally. Each Full Time Equivalent (FTE) denotes one full time employee. Total FTEs
denote total workforce generated by health centers. For the definition of FTE, see Appendix B.
Source: Capital Link, Inc with MIG, Inc. IMPLAN Software Pro version 2.0.1025 and 2004 structural matrices with the
2002 state level multipliers. Direct CHC Operating Expenditures derived from Bureau of Primary Health Care, HRSA,
DHHS, 2005 Uniform Data System.
Table 2
Total Economic Activity Stimulated by an Average Large Urban and
Small Rural Health Center, 2005
Large Urban Health Center
Total Economic
Impact
Small Rural Health Center
Employment (Full
Time
Equivalents)
Total Economic
Impact
Employment (Full
Time
Equivalents)
Direct
$
12,252,801
187 $
3,333,321
45
Indirect
$
2,273,314
24 $
261,600
3
Induced
$
7,114,112
70 $
287,124
4
Total
$
21,640,227
281 $
3,882,045
52
Note: Total Economic Impact includes Value-Added Impact. For an explanation, see Appendix B.
Actual health center with an annual budget of $12.3 million (large) and $3.3 million (small), based on
Capital Link’s financial information database. Each Full Time Equivalent (FTE) denotes one full time
employee. Total FTEs denote total workforce generated by health centers. For the definition of FTE,
see Appendix B.
Source: Capital Link, Inc with MIG, Inc. IMPLAN Software Pro version 2.0.1025 and 2004 structural
matrices with 2004 county level multiplier. Direct CHC Operating Expenditures derived from Fiscal
Year 2005 audited financial statements.
Table 3
Health Center Economic Impact by State, 2005
North Dakota
Alabama
$ 121,382,364
Kentucky
$ 145,069,297
Alaska
$ 144,528,348
Louisiana
$ 78,432,187
Ohio
Arizona
$ 286,830,888
Maine
$ 95,132,259
Oklahoma
Arkansas
$ 78,795,465
California
$2,037,609,155
Colorado
Connecticut
$ 14,662,971
$ 232,736,644
$ 59,581,749
Maryland
$ 201,502,347
Oregon
$ 292,735,806
Massachusetts
$ 610,958,760
Pennsylvania
$ 337,934,781
$ 373,364,151
Michigan
$ 323,832,254
Rhode Island
$ 67,410,498
$ 199,959,243
Minnesota
$ 127,925,653
South Carolina
$ 201,023,876
Delaware
$ 15,092,736
Mississippi
$ 148,879,146
South Dakota
$ 33,223,901
District of Columbia
$ 71,586,512
Missouri
$ 278,798,343
Tennessee
$ 171,825,379
Florida
$ 537,168,777
Montana
$ 44,619,157
Texas
$ 560,203,991
Georgia
$ 163,682,141
Nebraska
$ 34,274,030
Utah
$ 60,401,822
Hawaii
$ 117,206,087
Nevada
$ 33,600,556
Vermont
$ 34,069,199
Idaho
$ 64,286,155
New Hampshire
$ 59,285,597
Virginia
$ 143,116,890
Illinois
$ 658,087,959
New Jersey
$ 225,955,243
Washington
$ 610,452,536
Indiana
$ 123,745,679
New Mexico
$ 192,466,789
West Virginia
$ 294,209,387
Wisconsin
$ 229,500,072
Wyoming
$ 18,383,772
Iowa
$ 77,082,402
New York
Kansas
$ 35,089,879
North Carolina
United States
$ 1,143,732,348
$ 203,433,165
$ 12,558,691,991
Source: NACHC, Access Granted: The
Primary Care Payoff, 2007
www.nachc.com/research
Future Impact

Federally qualified health centers could
serve 30 million patients by 2015.

The estimated operating expenditures is
$23.5 billion.

Projected expenditures - an estimated
total economic impact of $40.7 billion.

Creating more than 460,000 full time
equivalent jobs in 2015.
Challenges Ahead
Expansion
 Investment
 Workforce

For More Information
Contact:
Dan Hawkins
[email protected]
Bob Phillips
[email protected]
Falayi Adu
[email protected]
View Both Access Denied and Access Granted at:
www.nachc.com/research