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Study: Medicaid Beneficiaries Get Better Care at Community Health Centers

By Reed Cooley, CQ Staff

August 14, 2008 -- Community health centers (CHCs) provide significantly more preventive care to Medicaid beneficiaries and the uninsured than do other primary care facilities, which researchers said has saved the publicly funded health centers billions of dollars yearly, according to a new study released Thursday by the George Washington University Medical Centers.

Uninsured patients seeking care at a CHC were 22 percent more likely to receive a Pap smear and 17 percent more likely to have a breast exam than were non-CHC patients without coverage. When Medicaid beneficiaries were added to the mix, CHC patients were 14 percent more likely than non-CHC patients to receive either procedure.

"The findings document that while health centers serve the most vulnerable populations at the greatest risk for poor health outcomes, their patients are getting more preventive care," Julio Bellber said in a press release. Bellber is president and CEO of the RCHN Community Health Foundation, which collaborated with the Geiger Gibson Community Health Center on the report.

Medicaid experts representing the American Hospital Association, a lobby for private providers, could not be reached for comment.

The study did not address the percentage of privately insured patients receiving preventive care measures from CHCs and other health care providers. George Washington University scholar and an author of the report Sarah Rosenbaum said that this was due in part to a lack of data but added that the question of preventive care for the privately insured was worthy of another study.

Privately insured individuals make up 15 percent of CHC patients but only contribute to 5 percent of CHC revenues. Rosenbaum attributed this to more limited reimbursement and lower efficiency in the payment system of private plans. "Private insurers, unlike Medicaid, are much worse payers," she said.

By law CHCs are required to be placed in areas deemed medically underserved and to adjust fees in accordance with patients' ability to pay. There are nearly 7,000 such facilities in the United States, and more than 67 percent of all CHC patients are racial and ethnic minorities, while 27 percent speak a first language other than English and 39 percent are uninsured, according to the report.

The report's authors found that CHCs spent an average of 41 percent or $1,810 less per patient than other primary care providers, a rate that amounted to an estimated total savings of between $10 billion and $18 billion in 2004.

Still, the picture isn't perfect for CHCs, which face severe burdens associated with the increasing health care costs.

A report released Tuesday in the policy journal Health Affairs describes how "safety net" providers including CHCs are "caught in the competitive cross-fire" of the profit-driven health care market. Safety net hospitals have experienced increased market pressures resulting from a spike in uncompensated care as more and more mainstream providers are refusing patients who are unable to pay. This trend has caused some safety net hospitals to adjust marketing techniques in hopes of attracting more privately insured patients and attempting to shed the safety net image, said the report funded by the Robert Wood Johnson Foundation.

Rosenbaum said that in many communities CHCs are able to attract privately insured plans, particularly those designed for lower income individuals, which tend to yield high deductibles.

However, many CHCs suffer from severe underfunding that limits their ability to treat un- and "underinsured" patients, according to Rosenbaum.

"If the government does not radically increase the grants, the pressure is on uninsured patients," she said, adding that this pressure would also be on those with insufficient, high-deductible plans.

The Health Affairs study focused more generally on access to care. "Expansion of insurance coverage is the most direct way to relieve some of the financial pressure on safety-net providers," the report said.

John Reichard contributed to this story.

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