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Primary
Care
Overview
Ensuring primary care services, such as regular check-ups,
starts with ensuring affordable, available, and accessible
services. Do residents have insurance or are free/low
cost services available? Do the services exist within
the community? Can the poor, elderly, and disabled access
services? Are hours for transportation compatible with
working parents? RC/EZ/ECs have access to a variety
of resources that can assist in ensuring primary care
services are affordable, available, and accessible to
their residences. For example, Community
Health Centers, the Public
Housing Primary Care Program, SCHIP,
Medicare, Medicaid,
and the Faith
Partnership Initiative.
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Stories
and Models from the field
Komed Center Offers Low-Cost Health Services to
Low-income Chicago Residents
Chicago, Illinois EZ - Round I
Komed Health Center, located in the Chicago EZ, sits
amid the largely African-American community of Bronzeville.
The center was created to make regular healthcare more
accessible to residents of the area and to neighboring
communities such as Grand Boulevard, Kenwood, New City,
Oakland, Washington Park, and Woodlawn. It is a general
health clinic which offers pediatric, internal medicine,
comprehensive obstetrics and gynecology services as
well as dental services. Continuity of care is extremely
strong because clinic providers offer careful, regular
follow up to patients. The Komed Center has provided
primary care services to more than 7,000 individuals
for an average of 2.5 visits per year. Komed offers
services on a sliding fee scale basis, with the average
patient fee at approximately $15. Fees are kept low,
in part, because volunteers provide some services. Care
is provided free of charge to approximately half of
clinic patients who are uninsured. With no other access
to primary care services, many of these patients would
have to resort to emergency room care when their condition
deteriorated. In addition, Komed accepts public aid
for children under age 20.
Now that the clinic has recently been expanded and
is fully operational, the Chicago EZ hopes to serve
more patients annually. EZ staff also anticipate the
availability of at least 10 full-time positions in the
near future as well as referrals for at least 25 residents
for on-the-job training.
For more information contact Ron Carter, Special Assistant
to the Mayor and Executive Director, Chicago EZ at 312-744-9623.
Service Integration and Community Coordination Improve
Access to Primary Care
El Paso, Texas EC (Round I EC, Round II EZ)
Limited access to affordable primary health care services
was a major problem identified at EC neighborhood planning
meetings. Almost all successful outreach programs for
increasing access to primary care include some aspects
of service integration and community coordination. The
El Paso EC plan called for expanding primary health
care services in the EC Zone by a number of activities.
One of the activities was to provide support to Project
Vida, an existing network of private and public partnerships,
that work together to address community needs. The network
community center located in the zone has a target population
of the low-income, Hispanic community. The center operates
a clinic that provides primary care to medically underserved
residents, with no other access to regular care. The
center's concept is that of "one-stop shopping" for
service delivery.
The project has helped to improve access to primary
care in the EC. Ninety-seven percent of the infants
and children registered with the program are up to date
with their immunizations, and more than 1,000 families
now have a local primary health care provider. Two hundred
and fifty families who previously used emergency room
services for primary pediatric care have not returned
to the emergency room since entering case management
and home visitation programs offered by the project.
EC Grant Enables Local Clinic to Provide Primary
Care to More Residents
Washington, District of Columbia
The nonprofit Washington Free Clinic serves people
who are uninsured and not eligible for Medicaid or Medicare.
The clinic is supported by a diverse group of local
funders and relies on donated time from health professionals
to stretch its annual budget to serve more people. The
clinic is located in the heavily immigrant, working-class
Columbia Heights neighborhood, which lies within the
EC.
"We had been operating at capacity, having to concentrate
on emergencies and turn away people who needed chronic
disease management and employment physicals" says Sharon
Zalewski, Executive Director of the Washington Free
Clinic. A 1998 grant of $44,000 from the District of
Columbia EC has enabled the clinic to take on more than
100 EC residents as new patients.
The grant has enabled the clinic to reach out and offer
comprehensive primary care to its EC neighbors. It is
trying to fill some gaps in the healthcare safety net
in a city where more than 100,000 people are without
health insurance. DC leads the Nation in 6 of the top
10 causes of death, many of these conditions are either
preventable or can be controlled with appropriate medical
treatment, education, and support.
"This grant helped a lot. It paid for diagnostic testing
and part of the salary for a clinician" says Zalewski.
"We took on 140 new patients and members of their families
from the neighborhood within 9 months."
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Tools
Models That
Work Database – Bureau of Primary Health Care
The Models That Work Campaign identifies and promotes
the replication of innovative community-based models
for the delivery of primary health care to underserved
and vulnerable populations. This public-private partnership,
led by the Health Resources and Services Administration
(HRSA), offers support to organizations and communities
that are interested in increasing access to care and
eliminating disparities in health status for the millions
of America's neediest citizens.
Integrated Primary Care Community Based Health
System
HRSA's Bureau of Primary Health Care has developed
this chart to show what an Integrated Primary Care Community
Based Health System look like. It can be referred to
in the planning process.
Click here to view
the Integrated Primary Care Community Based Health System
Chart.
 | These technical assistance resources for RC/EZ/ECs were
funded by the Office of the Assistant Secretary for Planning and Evaluation,
U.S. Department of Health and Human Services (HHS), through a cooperative
agreement administered by the Health Resources and Services Administration
(HRSA), and prepared by the Public Health Foundation. Duplication
and adaptation, with credit, are encouraged. |  |
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Tips
for RC/EZ/ECs
- RC/EZ/ECs can use Enterprise Zone Facility Bonds
to attract health care providers (hospitals or managed
care organizations) to set up a local branch.
- RC/EZ/ECs can actively promote tuition reimbursement
and training programs that are available through Federal
agencies such as
HRSA.
- RC/EZ/ECs can petition jurisdiction leaders and
legislators to reduce property taxes for key health
care providers in the RC/EZ/EC.
- Hospitals and clinics in the RC/EZ/EC can partner
with public schools and use Qualified Zone Academy
Bonds for internship and mentoring programs.
- Design cultural competency training for current
health care providers in the RC/EZ/EC.
- Ensure transportation services are available for
people and that hours of operation fit with their
schedules.
- In the RC/EZ/EC annual benchmarks plan, include
transportation issues related to access to primary
care.
- Encourage hospitals, clinics, and doctor's offices
to adjust hours of operation to accommodate workers
and children who are in school.
- RC/EZ/ECs can partner with academic
health centers to provide low cost
primary care.
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Links
Bureau of
Primary Health Care
Over 43 million people in the United States lack access
to primary health care. The mission of the Bureau of
Primary Health Care (BPHC) is to assure that underserved
and vulnerable people get the health care they need.
BPHC is one of four Bureaus of the Health Resources
and Services Administration. This site contains information
on community-based primary care initiatives, a BPHC
service site locator, data sources and funding opportunities.
National Association
of Community Health Centers
The National Association of Community Health Centers
is the national trade association serving and representing
the interests of America's community health centers.
Browse this site for wide range of information on planning,
operations, training and resources.
Capital Link
Building additional clinic capacity in a community can
be an effective way to increase access to primary care.
Capital Link is a technical assistance organization
that assists community health centers in planning and
obtaining financing for building and equipment projects.
Because Capital Link receives funding from the Bureau
of Primary Health Care, most of the assistance is provided
without charge to health centers.
Medscape
Primary Care Section
This site contains useful information on primary care,
including a resource center for primary care news and
a searchable database of documents on a wide range of
primary care topics. This site requires a one-time user
sign-in form to be completed.
American
Medical Student Association
This site is oriented towards medical students, but
has useful information for community leaders concerned
about access to primary care. The project guides are
useful publications that were developed by the AMSA
Foundation's Generalist Physicians in Training project
under a grant form the Robert Wood Johnson Foundation.
They offer a quick way to get up-to-speed on a primary
care topic, along with resource lists and chapter project
ideas.
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