Community health centers: health care as it could be.

INTRODUCTION This Article explores the potential of community health centers (CHCs) to become a central component providing health care in America. It focuses on health centers as a proposed solution to the dual national problems of access to care and the shortage of primary care doctoring. It argues that CHCs have the capacity to address the problem of access to health services and to provide a vibrant model for the revival of primary care. Part I deals with the history, structure, current scope, and funding of CHCs. Part II looks at national health care goals and how CHCs are uniquely poised to actualize those goals. The demonstrated successes and potential growth of the CHC model are viewed against the backdrop of national health care priorities established through the Healthy People 2010 report. Part III looks at physician workforce issues, Graduate Medical Education (GME), and efforts to extend residency programs to ambulatory settings, including CHCs. State initiatives to reform GME so that it will produce a physician workforce better adapted to meet local health care needs are discussed, and the needs for federal action are identified. The role of the GME funding structure is examined as a key component in shaping potential reforms. Finally, the conclusion summarizes the benefits delivered by CHCs and notes the need for systemic shifts to help facilitate the growth of this successful health care model. The broader policy questions of how CHC expansion fits into health care policy reform as a whole will be left to another Article. Nonetheless, a brief overview of the current state of the U.S. health care crisis helps place the expanded need for CHC services in perspective. In August 2000, a groundbreaking World Health Organization (WHO) survey evaluating national health systems worldwide ranked the United States 37th in overall health system 1 J. Lesnik is currently a legal fellow at the American Civil Liberties Union of Northern California. She would like to thank her mentor, Sylvia Law, for enthusiasm and insight, her parents and sister, for their unwavering support, and Meher Baba, for his good humor and compassion. performance-sandwiched between Costa Rica and Slovenia. 2 This dismal showing occurred despite the fact that the United States spends more on health care than any other of the 191 WHO nations. 3 In 2004, U.S. health spending rose to a whopping 15 percent of the gross domestic product, a higher percentage than any …