Dylan Roby
Sara Rosenbaum
Dan Hawkins
March, 2003
National Association of Community Health
Centers, Inc., Washington, DC
Introduction
The 21st century has produced staggering
changes in Americas health care system. More and more Americans nearly
one in seven have no health insurance. Those who are fortunate
enough to have insurance are paying a higher share of the costs.
Indeed, health care premiums have soared 13 percent since last
year alone. Are the extra dollars paying off in terms of patient
satisfaction? The evidence suggests otherwise. While the American
healthcare system has, for the most part, made strides some of
them significant in improving the quality and effectiveness of
its care, the system has also been harshly criticized by the
public, who increasingly report that health care providers are
inadequate, inappropriate, and ineffective in meeting their needs.
In fact, the negative public reaction has been sufficiently strong
enough to spur action on a patients bill of rights in
many states, and in the halls of the U.S. Congress, where
lawmakers have debated over such legislation over the past 6
years.
The shortcomings of the U.S. health care
system were recently documented in a recent report from the
highly- regarded National Academy of Sciences Institute of
Medicine (IOM), entitled Crossing the Quality Chasm, which noted
that The U.S. health care delivery system does not offer
consistent, quality medical care to all people.4 Particularly
at risk for care that is neither timely nor of adequate quality
are low-income patients and persons without health insurance.
Extensive studies of these patients find consistent patterns of
health care delays, inappropriately limited access to necessary
care, and health care in inappropriate settings such as hospital
emergency rooms.5 The IOM report offers six Aims for Improvement
for the healthcare delivery system in the 21st Century: safety,
effectiveness, patient-centered care, timeliness, equitable care,
and efficient use of resources to provide care. The report
concludes that any healthcare system wishing to adequately meet
patient needs must first address the six Aims for Improvement.
Evaluating the quality and effectiveness of
health care entails two key dimensions. The first involves the use
of objective measurements of clinical care performance (both
definitive and comparative), while the second focuses on
evaluation of patients actual health care experiences.6 This
report presents the results of a major evaluation of the
performance of federally-supported Community Health Centers. The
findings presented here show that health centers furnish care of
high quality, as measured not only by clinical health quality
measures but also from patient information regarding their health
care experiences. The data from which these findings have been
drawn come from two point- in- time performance evaluations that
permit comparison over time. The results of these studies indicate
sustained and improved clinical care quality and patient
satisfaction levels over a decade, even as health centers have
experienced a significant growth in the proportion of uninsured
and vulnerable patients they serve.
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