Abstract
Although community-based health institutions in the United States have a foundational history in grassroots advocacy and community autonomy, today they face multiple barriers in promoting their community’s values and addressing their community’s material, political, and health needs. The goals of this chapter are to identify the institutional barriers that community-based health institutions (CBHIs) in the United States face to promote health in their communities and to propose solutions to overcome these institutional barriers in order to return to CHC’s purpose of empowering local community members to eliminate health inequalities. I argue that one of the fundamental ways that U.S. community-based health institutions can overcome these barriers and foment the grassroots advocacy that shaped the community health center movement of the 1960s and 1970s, is if the United States implemented a single-payer universal healthcare system. Examining the effects of the implementation of Patient Protection and Affordable Care Act of 2010 on federally-qualified health centers, I will identify the institutional barriers that CBHIs face to deliver patient-centered care, empower marginalized populations, and circumvent constant fiscal threat. In response to each barrier, I propose recommendations which include legislative and regulatory recommendations, organizational changes, grassroots involvement, and finally, implementing a single-payer system.
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Alberti, P. M. (2014). Community health needs assessments: Filling data gaps for population health research and management. eGEMs, 2(4), 1174.
Alberti, P. M., Bonham, A. C., & Kirch, D. G. (2013). Making equity a value in value-based health care. Academic Medicine, 88(11), 1619–1623.
Anderson, G. F., Hussey, P., & Petrosyan, V. (2019). It’s still the prices, stupid: Why the US spends so much on health care, and a tribute to Uwe Reinhardt. Health Affairs, 38(1), 87–95.
Barnes, A. J., Unruh, L., Chukmaitov, A., & van Ginneken, E. (2014). Accountable care organizations in the USA: Types, developments and challenges. Health Policy, 118(1), 1–7.
Blustein, J., Weissman, J. S., Ryan, A. M., Doran, T., & Hasnain-Wynia, R. (2011). Analysis raises questions on whether pay-for-performance in Medicaid can efficiently reduce racial and ethnic disparities. Health Affairs, 30(6), 1165–1175.
Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(S1), S149–S155.
Briggs, L. (2002). Reproducing empire: Race, sex, science, and US imperialism in Puerto Rico (Vol. 11). Berkeley, CA: University of California Press.
Epstein, S. (2008). Inclusion: The politics of difference in medical research. Chicago: University of Chicago Press.
Geiger, H. J. (2016). The first community health Center in Mississippi: Communities empowering themselves. American Journal of Public Health, 106(10), 1738–1740.
Human Rights Campaign. Understanding the transgender community. Retrieved on 15 March 2019 at https://www.hrc.org/resources/understanding-the-transgender-community
Israel, B., Eng, E., Schulz, A., & Parker, E. (Eds.). (2005). Methods in community-based participatory research for health. San Francisco, CA: Jossey-Bass.
Kaiser Famiy Foundation. (2017). Medicare delivery system reform: The evidence link. Retrieved from https://www.kff.org/medicare-delivery-system-reform-the-evidence-link/
Keith, K. Unpacking the House Medicare-for-All Bill. 3 March 2019. Health Affairs Blog: Following the ACA. Retrieved on 31 March 2019 at: https://www.healthaffairs.org/do/10.1377/hblog20190302.150578/full/
Keller, M. Seventy percent of Americans support ‘Medicare for all’ in new poll. 23 August 2019. The Hill. Retrieved on 30 March 2019 at: https://thehill.com/policy/healthcare/403248-poll-seventy-percent-of-americans-support-medicare-for-all
Kominski, G. F. (2013). Changing the US health care system: Key issues in health services policy and management. San Francisco: Wiley.
Levinson, D. (2017, August). Medicare Shared Savings Program Accountable Care Organizations have shown potential for reducing spending and improving quality. Department of Health and Human Services Office of the Inspector General. Retrieved 27 January 2019 at: https://oig.hhs.gov/oei/reports/oei-02-15-00450.asp
McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine, 374(24), 2357–2366.
Medicaid Innovation Accelerator Programs. (2017, 18 May). Promoting Community integration through long-term services & supports in state medicaid-housing agency partnerships: Program overview. Retrieved on 25 January 2019 at: https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/iap-downloads/program-areas/partnerships-program-overview.pdf
Merlis, M., Berenson, R. A., & Fisher, E. S. (2010). Health policy brief: Accountable care organizations. Health Affairs, 7, 27.
National Association for Community Health Centers. (n.d.) Dr. H Jack Geiger and Dr. John Hatch on the earliest CHCs. Retrieved at: https://www.chcchronicles.org
National Association for Community Health Centers & John Snow, Inc. (2013). Health centers and payment reform: A primer. Emerging issues #7, October 2013. Retrieved at: http://www.nachc.org/wp-content/uploads/2015/11/Health-Centers-and-Payment-Reform.pdf
National Association for Community Health Centers. (2018). About our health centers. Retrieved from: www.nachc.org/about/about-our-health-centers/
Navarro, V. (2010). Consequences of the privatized funding of medical care and of the privatized electoral process. American Journal of Public Health, 100(3), 399–402.
Peters, G., & Woolley, J. T. (1996). “William J. Clinton. “Statement on Signing the Health Centers Consolidation Act of 1996,” October 11, 1996”. The American Presidency Project. University of California-Santa Barbara.
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science & Medicine, 128, 316–326.
Planned Parenthood Federation of America. “Hyde Amendment.” Retrieved on 3 March 2019 at: https://www.plannedparenthoodaction.org/issues/abortion/hyde-amendment.
Pollin, R., Heintz, J., Arno, P., Wicks-Lim, J., & Ash, M. (2018). Economic analysis of Medicare for all. November. Political Economic Research Institute. University of Massachusetts-Amherst. Retrieved on 30 November 2018 at: https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all
Rodríguez, M. A., Young, M., & Wallace, S. P. (2015). Creating conditions to support healthy people: State policies that affect the health of undocumented immigrants and their families. Los Angeles, CA: University of California Global Health Institute.
Salganicoff, A. & Rice, C. (2019). Alina Salganicoff answers 3 questions on final title X regulations for family planning clinics. Kaiser Family Foundation, 27 Feb 2019. Retrieved at: https://www.kff.org/womens-health-policy/issue-brief/ask-kff-alina-salganicoff-answers-3-questions-on-final-title-x-regulations-for-family-planning-clinics/
Schulman, K. A., & Richman, B. D. (2016). Reassessing ACOs and health care reform. JAMA, 316(7), 707–708.
Scott, W. R., Ruef, M., Mendel, P. J., & Caronna, C. A. (2000). Institutional change and healthcare organizations: From professional dominance to managed care. University of Chicago Press. Chicago, IL.
Sharma, A. E., Huang, B., Knox, M., Willard-Grace, R., & Potter, M. B. (2018). PatientEngagement in community health center leadership: How does it happen? Journal of Community Health, 43(6), 1069–1074.
Shim, J. (2005). Constructing ‘race’ across the science-lay divide: Racial formation in the epidemiology and experience of cardiovascular disease. Social Studies of Science, 35(3), 405–436.
Song, Z., & Fisher, E. S. (2016). The ACO experiment in infancy—looking back and looking forward. JAMA, 316(7), 705–706.
Stroumsa, D. (2014). The state of transgender health care: Policy, law, and medical frameworks. American Journal of Public Health, 104(3), e31–e38.
Suro, R., Suárez-Orozco, M. M., & Canizales, S. (2015). Removing insecurity: How American children will benefit from President Obama’s Executive Action on Immigration. USC Sol Price School of Public Policy, Tomas Rivera Policy Institute, April 2015, USC/UCLA. Retrieved on April 27, 2015 from: http://trpi.org/pdfs/research_report.pdf.
Tarlov, A. R. (1999). Public policy frameworks for improving population health. Annals of the New York Academy of Sciences, 896 (Special Issue: Socioeconomic Status and Health in Industrial Nations: Social, Psychological and Biological Pathways), 281–293.
The Engelberg Center for Health Care Reform & the Dartmouth Institute. (2013, June). Opening Plenary Session of the Fourth National Accountable Care Organization Summit, Washington, D.C.
The Guttmacher Institute. “Federally Qualified Health Centers Could Not Readily Replace Planned Parenthood.” 17 May 2017. https://www.guttmacher.org/news-release/2017/federally-qualified-health-centers-could-not-readily-replace-planned-parenthood
The TransActive Gender Center. (n.d.). “About Us.” Retrieved on 22 March 2019 at: https://www.transactivegendercenter.org/about-us
Washington, H. A. (2006). Medical apartheid: The dark history of medical experimentation on black Americans from colonial times to the present. New York: Doubleday.
White, J. (2018). Hypotheses and hope: Policy analysis and cost controls (or not) in the Affordable Care Act. Journal of Health Politics, Policy and Law, 43(3), 455–482.
Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217–228.
Woolhandler, S., & Himmelstein, D. U. (2017a). The Affordable Care Act: How Nixon’s health reform proposal became Democrats’ Albatross. International Journal of Health Services, 47(4), 612–620.
Woolhandler, S., & Himmelstein, D. U. (2017b). Single-payer reform the only way to fulfill the President’s pledge of more coverage, better benefits, and lower costs. Annals of Internal Medicine, 166(8), 587–588.
Wright, B. (2013). Who governs federally qualified health centers? Journal of Health Politics, Policy and Law, 38(1), 27–55.
Wright, B. (2015). Do patients have a voice? The social stratification of health center governing boards. Health Expectations, 18(3), 430–437.
Wright, B., & Martin, G. P. (2014). Mission, margin, and the role of consumer governance in decision-making at community health centers. Journal of Health Care for the Poor and Underserved, 25(2), 930.
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Martínez, A.D. (2019). Overcoming Institutional Barriers Faced by Community-Based Healthcare Institutions. In: Arxer, S., Murphy, J. (eds) Community-Based Health Interventions in an Institutional Context. International Perspectives on Social Policy, Administration, and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-24654-9_12
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