“Generally I am in good health, but when I do need to go to the doctor, I’m glad that Bailey’s clinic is available. I work as a stocker at a big box store, and they don’t provide health care. I only make $9.25 dollars an hour, so I certainly wouldn’t be able to afford private health insurance.
At the Community Health Care Network Clinic, I only pay five dollars per visit, and I never have to wait for very long; often times they’re able to see me as soon as I walk in. English is my second language, so I also really appreciate that most of the staff there speak Spanish.
I recently needed an MRI and was worried about the cost. But through the Fairfax County health system I only paid $10. There is no way I would have been able to afford that otherwise.” –Raul Luna, Fairfax County, VA
Across the country, the second week of August is celebrated as National Health Center Week, an annual event highlighting the role of community, migrant, and homeless health clinics in providing affordable, quality health care to all people, regardless of ability to pay. The week is an opportunity to recognize the work of the clinics that have been a critical, if underappreciated, component of the U.S. health care infrastructure for 45 years. Currently, clinics provide a medical home for over 20 million people in America, mostly people of color and low-income people–the people who face the most barriers to quality care–and play an important role combating the racial and ethnic disparities in our health care system.
Clinics and Racial and Ethnic Health Disparities
Our health care system provides vastly unequal access and treatment based on race, language, and ethnicity. Racism within the health system is literally making people of color sick: African Americans, Native Americans, and Latinos have higher rates of death from diabetes than whites, and Native American and African American children suffer higher rates of death from asthma as white children. Clinics are critical in addressing these inequities. Nearly two-thirds of all patients served by clinics are people of color (about 33% Latino, 25% African Americans). And almost one-third of them are Limited English Proficient (LEP) and require language services when receiving medical attention.
Thankfully, clinics are well-positioned to meet the needs of these communities because they must meet a set of requirements in order to qualify for federal funding. These include:
- Being located in medically underserved communities
- Providing tailored services to meet the unique needs of the communities they serve
- Being available to all residents regardless of income and insurance status
Because of these requirements, clinics present people with fewer barriers to accessing care than other health care providers. This is doubly important, since their patients are often the people who need health services the most.
While profit-seeking hospitals and doctors choose not to practice lower-income communities and communities of color, clinics operate in the heart of them. Their commitment to meeting the basic needs of their patients translates into people getting linguistically and culturally appropriate care. Because they can communicate in their native languages, trips to the doctor aren’t marred by confusion and fear. And by allowing patients to pay on a sliding scale according to how much they can afford, clinics minimize financial obstacles. Patients won’t ignore health problems for fear they can’t afford care, nor will they be financially devastated by necessary tests and services. All of these are integral to reducing the drastic racial and ethnic disparities in health.
Clinics and Immigrant Access to Health Care
Clinics are indispensable for immigrant communities in the U.S. Nearly half of all immigrants in the U.S. have no health insurance, and the number is even closer to 59% among undocumented people. Immigrants with status have a difficult time gaining access to public health insurance such Medicaid and the Children’s Health Insurance Program and undocumented immigrants are barred completely from these programs. Clinics are often their only source of health care.
Clinics are the medical homes for six out of ten uninsured immigrants and over one in three insured immigrants. Geographic and financial restraints are certainly factors behind these high numbers, but they aren’t the only ones. Patients don’t just go to clinics because of things they lack, but also because they are pleased with the care they receive in clinics. Nearly all LEP clinic patients report that their clinician speaks their same language. And, because clinics are governed by a community board that includes patients, they understand and respect the culture of their patients, which in turn means they can better meet their needs.
In the wake of health care reform, clinics are even more critical for the health and well-being of undocumented immigrants. In addition to being ineligible for public health insurance, true both before and after reform, immigrants without status will be barred from purchasing insurance through the state health insurance exchanges currently being developed. Options for health care are slim and getting slimmer for this community, which means many hardworking people will get sick, remain sick, and grow even sicker without any help.
Clinics into the Future
Clinics have received a huge infusion of dollars in the past couple of years, and will continue to see increased funding until 2015. In 2008, President Bush acknowledged their importance and doubled spending on health clinics, and President Obama continued the trend by allocating more money through the economic stimulus package and health care reform. Health clinics now have resources to build new facilities, renovate old ones, hire more providers, and serve more patients.
On a national level, we will need to stay vigilant to guarantee continued funding for health centers. On the local level, it’s important that people work to bring in clinic funding where it is most needed in their communities, whether that means building new health centers, improving existing ones, or making sure clinics are staffed with enough medical translators. Community members must also develop relationships of accountability with their clinics and ensure that they continue to provide the quality, affordable, culturally-appropriate care that is the right of every patient.
Photo: Patients of Chicago’s Centro de la Salud Esperanza at their clinic’s National Health Center celebration