This week marks the fortieth anniversary of the first community health centers in the country.
Thirty four years ago, New Hampshire was home to one fledgling center with just one doctor.
Now the twelve centers in the state serve over eighty thousand patients a year, and are considered essential to healthcare for the poor, the uninsured, and the underinsured.
New Hampshire Public Radio’s Kerry Grens has a look at how community health centers have evolved over the years.
Bulldozers smooth over big mounds of dirt in what used to be the front lawn of Lamprey Health Care in Newmarket.
Peters: …we are doubling the square feet of the health center, our current center is overcrowded…
Executive director Anne Peters explains the center needs more exam rooms, a meeting place for health education, and an x-ray facility.
Through a combination of grants, state and federal funds, and insurance payments—mostly Medicaid—the center serves over sixteen thousand patients a year.
Most of them are low income and a third have no insurance at all.
Despite these fiscal disadvantages, Lamprey Health Care has ballooned in size since its inception in 1971.
Anne Peters came on board twenty six years ago.
Peters: At that point in time we had 19 employees and we have close to 200 today and I think our budget was 300 thousand dollars and our budget today is approximately 11 million. So it has definitely grown as our community has grown.
Gone are the days of the modest community health center, giving vaccines and check-ups out of church basements or old storefronts.
They are now leaders in contemporary medical trends in prevention and chronic disease management.
Peters says the centers adapt constantly to adapt to better serve New Hampshire’s changing population, one that is getting older, with more chronic diseases, and also that’s becoming more diverse.
Peters: Our Nashua center is just about fifty percent non-english speaking or esl. And that has been a challenge and it’s also been exciting it’s wonderfully enriching. We have close to 45 percent of our staff who speak another language in that center. It removes the barrier of language on access to care. And that’s been a wonderful development.
There are now twelve community health centers in New Hampshire and over a thousand nationwide.
They serve fifteen million people a year.
And although the system is constantly expanding, founder Jack Geiger says they still adhere to their original philosophy.
Geiger: The commitment of community health centers is that people will get care whether or not they have insurance and whether or not they have the ability to pay.
Geiger based his ideas on a system he’d seen during a medical fellowship in South Africa.
Medical students there had created community health centers to care for the impoverished Zulu population that could not otherwise get healthcare.
But it wasn’t until he went to Mississippi during the civil rights movement of the early sixties that Geiger realized that the South Africa model would work here.
Geiger: And I took a long look around and realized that I didn’t have to go to Africa or Latin America or Southeast Asia we had those problems here in the United States. In the rural South, in the urban ghettos of the North, on the Indian reservations, in Appalachia, and all kinds of places across the country.
The first two centers opened in Boston and Mississippi.
Those and all the subsequent centers have preserved the South African model of having over half its board of directors comprised of patients.
Geiger: So this is the one part of the whole healthcare system in the united states where patients really have a voice in what services are going to be provided who the executive director is going to be what the hours of service are going to be and how problems in the delivery of healthcare are going to be solved.
Jim Wells is uninsured.
He couldn’t afford treatment for his diabetes until he went to the Health First Family Care Center in Franklin.
Wells: I don’t know what I would do. Insurance is very expensive, I’m single, sixty years old, my insurance would run around six hundred dollars a month if I could get it because I do have a chronic illness they don’t want to deal with me. I come here, my copay is very small and it’s a wonderful system.
Wells now sits on the center’s Board of Directors.
His goals are to enlarge the center and get the word out to people who aren’t aware of it.
Wells’s ambitions are aligned with those of politicians spanning the political spectrum.
The system began as the darling of liberal Democrats like Senator Ted Kennedy and President Lyndon Johnson.
It’s now praised by conservative Republicans like President Bush and Senator John Sununu.
Sununu: I think because they work locally. They are so tied to the community in terms of their boards, their clients and their partners they tend to be very efficient. It’s the structure that allows them to be efficient and effective in delivering the healthcare and that in turn makes them very popular.
Dr. Geiger says that providing healthcare where there was none saves money.
Geiger: The evidence is very clear that wherever you have a community health center there is a dramatic drop in people having to go to emergency rooms or having to be hospitalized for conditions that could have been nipped in the bud with primary care much earlier.
But despite the evidence and the praise, health centers still struggle.
This week the National Association of Community Health Centers released a report called The Safety Net On the Edge.
It details the rise in uninsured patients and changes to Medicaid in some states that threaten health center revenue.
Kuenning: In the fifteen years I’ve been with the health centers I don’t know an easy time for them.
Tess Kuenning is the director of bistate primary care association for New Hampshire and Vermont.
She says that New Hampshire centers have seen a fifty percent increase in uninsured patients in the last five years.
But financial problems don’t shake her confidence in the centers’ longevity.
Keunning: There are pressure points at all levels of the revenue, but the community health centers have survived in really difficult economic times over forty years. And I suspect because they are such an important part of the infrastructure for the public health that they will continue to thrive.
Despite her optimism, Keunning still worries about proposals to change Medicaid.
She doesn’t want to see cost-saving ideas like adding copays or premiums preventing anyone from seeking care.
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