Primary care, community clinics - - Bureau of Primary Care

I was having lunch with a medical school classmate, an inspector for the Joint Commission. He was telling me how impressed he was with the Bureau of Primary Care clinics. I was non-plused. I have written extensively about primary care shortages, and I had not heard of these clinics.

Lasting Bush Legacy

These clinics are considered the most lasting health care legacy of the Bush administration. Starting in 2001, President Bush more than doubled funding for these clinics, a subdivision of the HSRA (Health Services Research Association).
There are now 1297 clinics serving poor urban neighborhoods, rural regions, and Indian reservations. The clinics are often the only dependable providers of prenatal care, childhood immunizations, asthma treatment, cancer screenings, and tests for sexually transmitted disease.

The clinics saved the government more than $700 million in 2007 by serving as a cost alternative to emergency rooms. Clinics serve more than one of three living in poverty, and one of eight of the uninsured.

Clinic Clients

The bureau’s clinics, which must be governed by patient-dominated boards, are said to be well managed, efficient, and compassionate. They reduce racial and ethnic care disparities and keep people out of hospitals. They serve populations with limited access to primary care, those with poor English proficiency, the newly arrived, the homeless, and migrant and seasonal migrant workers. They are supported by a combination of federally qualified grants for local, regional, state, and federal sources, and by monies from those who can afford to pay.

Patient Mix
In 2005, the clinics cared for more 16 million patients, including 2.8 million who had dental care, 617,000 with mental health problems, 2.5 million with private insurance, 1.2 million with Medicare, 5.7 million with Medicaid, and 6.2 million uninsured.

One Deep Frustration

One deep frustration is difficulty arranging follow-up appointments with specialists for the uninsured and Medicaid patients. Perhaps that can be remedied by expanding coverage for the uninsured and by raising Medicare rates enough to cover doctors’ overhead costs.