Almost half of the medically underserved areas (MUAs) nationwide (43%) lacked a community health center site in 2007—down 3% since the previous year, according to figures released May 1 by Government Accountability Office (GAO).
This increase in centers is related in part to more federal funding for the centers, according to Cynthia Bascetta, director of healthcare with GAO. However, some areas of the country may be disproportionately affected: the Midwest census region had the most MUAs that lacked a health center site (62%) while the West census region had the fewest MUA's without site (32%), she said at a Senate hearing the day before on community centers.
These percentages are important when one considers that more than 60 million Americans, many with insurance, "can't find a medical home--can't find a doctor, a dentist, mental health counselor, and can't get access to prescribed medications," said Bernard Sanders (I-VT), who chaired the Senate Health, Education, Labor and Pensions Committee hearing.
"There's not going to be real reform or [creation of] cost effectiveness to a healthcare system . . . unless we address that issue." He added, though, that changes may be coming with a doubling of the amount (to $4 billion) to fund community health centers under the stimulus law.
Daniel Hawkins, a senior vice president with the National Association of Community Health Centers, said at the hearing that the centers "cost significantly less money--saving the health system overall." For instance, a recent national study done in collaboration with the American Academy of Family Physicians found that healthcare centers save the healthcare system about $18 billion annually.
If this was extrapolated further--for instance, if every person in America received care that health centers provide--more than $500 billion a year could be saved in healthcare spending, Hawkins said. One of the reasons is less specialty care—but whether it's because health center patients are getting less specialty care or other patients outside the centers are getting more specialty care than necessary remains to be studied, he said.
Fitzhugh Mullan, MD, noted that the density of physicians today is 272 per 100,000 population, which puts the U.S. "in the middle of the pack" in terms of physician-patient ratio in industrialized countries. However, the distribution of physicians across the country leans more to urban and well-to-do areas.
Less than 10% of the country's physicians practice in rural areas, while 20% of the population lives there, Mullan said. Metropolitan areas have primary care ration of 93 physicians per 100,000 people compared with 55 physicians per 100,000 people in non-metropolitan areas, Mullan said.
In addition, he said that only 2% of medical student questioned in a medical survey said they wanted to be general internists. As one study predicts, this means that the U.S. could be short by approximately 40,000 primary care physicians in 15 years. Increased investment in the National Health Service Corp could help expand the number of physicians practicing nationwide, especially in high-need areas served by community health centers.