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Authorizing Safety Net Public Health Programs
Subcommittee on Health
Ms. Elizabeth James Duke
Mr.
Chairman, Members of the Subcommittee, thank you for the opportunity to speak to
you today about health care in America. I
am Betty James Duke, Acting Administrator at the Health Resources and Services
Administration, an agency
within the Department of Health and Human Services.
The
Health Resources and Services Administration, otherwise known as HRSA, is
committed to working toward 100 percent access and zero disparities.
To achieve this goal, HRSA works closely with State and local governments
and organizations to build a foundation for a national safety net of health care
services that promote the health and well-being of our nation's most
vulnerable individuals and families. Under
the leadership of President Bush and Secretary Thompson, HRSA is prepared to
reinforce and expand the health care safety net to reach more vulnerable
Americans who are in need of primary health care services.
The Administration's commitment is evident in its FY 2002 financial
support for the cornerstone of HRSA's safety net programs B
the Community Health Centers. Community
Health Centers
As
the foundation for health care safety nets in more than 3,200 communities
nationwide, community health centers deliver family-oriented preventive and
primary health care services to approximately 10.5 million people who live in
medically underserved rural and urban communities.
The
President's FY 2002 Budget request includes nearly $1.3 billion for Community
Health Centers, an increase of $124 million above the FY 2001 appropriation.
Funding at this level will allow health centers to increase the number of
existing and expanded health care access points by 200, providing services for
up to one million additional people, including 460,000 uninsured.
This increase is the first installment of a multi-year initiative to
increase or expand health center access points by 1,200 by FY 2006 and
eventually double the number of people served. Through
the President's Community Health Center Initiative, new grantees will address
the health care problems that they encounter in their community.
We will see small health centers grow to meet the increasing needs and
demands for their services. And we
will see mid-size grantees grow into large-scale operations as these additional
resources provide them the chance to serve even more of the medical needs for a
growing and aging population. Community
Health Centers serve our most vulnerable populations.
The Health Center patient population consists of approximately:
Health
Centers serve one in every six low income children, one in every 10 low income
uninsured individuals, one in every 8 Medicaid recipients, one in every 4
homeless persons, one in every 5 migrant farm workers, and one in every 12 rural
residents. The homeless community is particularly in need of
health services -- nearly 550,000 homeless patients (75 percent of whom are
uninsured) are served through culturally competent clinicians. Also, nearly 600,000 patients of Health Centers are
migrant-farm workers. In
calendar year 1999, health centers provided a full range of culturally competent
primary and preventive health services over 36.6 million encounters.
These services included:
Health
Centers have demonstrated their effectiveness by:
In
collaboration with state and local community partners, HRSA's community health
centers are an indispensable component of the national health care safety net. National Health Service Corps Health
care at many community health centers is provided by medical professionals
serving in HRSA's National Health Service Corps (NHSC).
The NHSC has been a critical element in local safety nets for over 25
years. Since 1972, the National
Health Service Corps, through its scholarship and loan repayment programs, has
placed over 22,000 healthcare clinicians in areas with a health professional
shortage. Today, 2,500 NHSC
clinicians serve in border towns, rural areas, and inner cities, in every State,
the District of Columbia, Puerto Rico, and the Pacific Basin.
The
FY 2002 Budget launched a Presidential Management Reform Initiative for the
National Health Service Corps so it will be better able to address the neediest
communities. We are examining the
ratio of scholarships to loan repayments, as well as other set-asides, to ensure
maximum flexibility in placing NHSC providers.
We will also seek to amend the Health Professional Shortage Area
definition to reflect other non-physician providers practicing in communities,
which will enable the NHSC to more accurately define shortage areas and target
placements better. To further avoid
overlap in the provision of health care, HHS has begun its coordination with
immigration programs, including the J-1 and H-1C visa programs, which review
applications for health care providers practicing in underserved communities.
These
reform proposals will build on the existing success of the NHSC and in turn
strengthen the national safety net since many NHSC providers spend all or part
of their careers serving where others choose not to go.
The NHSC has had remarkable success in placing its providers:
Rural
Health and Telehealth HRSA
remains sensitive to the needs of America's rural populations, who often lack
ready access to health care providers. HRSA's
Office of Rural Health Policy coordinates rural health policy issues within the
HHS and is the Department's focal point for coordinating public- and
private-sector efforts to strengthen and improve the delivery of health services
to populations in rural areas nationwide. HRSA=s
Rural Health Outreach grants emphasize health care service delivery through
creative strategies that require each grantee to form a network with at least
two additional partners. By
developing new health care delivery systems, these grants have improved access
to care for more than 2.9 million citizens in rural areas.
The
Rural Health Network Development grants assist in developing organizational
capacity in the rural health care sector through formal collaborative
partnerships that involve shared resources.
Through these grants, communities can acquire staff, technical experts,
and other resources needed to build successful health care networks.
Bringing
health care to rural areas means creating and building medical infrastructure
and allowing patients to heal in their own communities. We know that patients tend to do better when they are treated
closer to their homes. Friends and
family can visit them, and show them their encouragement.
And knowing that the physician lives in your home community, that he sees
the same things that you do, and that she is an active participant in the
school, increases confidence, and cultural competence. Also
to increase the strength of the safety net we will look to more tightly weave
telehealth into areas where physicians do not have the experience in treating
specific diseases. Since 1988, our
growing telehealth network continues to provide increasing access to health care
expertise to emerging communities and rural areas.
As we link these offices using state-ofBthe-art
equipment and advanced technology to expert centers of disease and sickness
management, we are providing critical, life-saving information to health care
providers who would otherwise lack the specific expertise. Community
Access Program As
outlined in the President's FY 2002 Budget, the Administration proposes the
elimination of the Community Access Program (CAP).
After a careful review, the Administration concluded that further
fragmenting the resources available to public health providers by establishing
yet another funding stream was not the most effective or efficient way to
improve health care access for the uninsured.
Rather, the Administration believes we should invest in proven programs
like Community Health Centers and Medicaid.
HRSA
provides communities with access to existing funding resources that would enable
them to pursue the same goals as CAP. For
example, Community Health Center funding already supports an Integrated Service
Delivery Initiative (ISDI), which provides funding to health centers to
encourage them to integrate functions with other centers and safety net
providers in their communities. In addition, in FY 2000, HRSA targeted $41
million of its funding increase for a Health Center investment process to fund
existing health center grantees that demonstrate effectiveness at serving a
disproportionate share of uninsured and under-insured patients. As
I mentioned in the beginning of my testimony, HRSA and the Administration are
committed to ensuring access to basic, quality health care now and in the
future. We have spent a great deal
of time and effort to strengthen and streamline HRSA programs and services that
will lead to a tighter, stronger health care safety net.
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