In California over 600 community clinics provide an essential set of services to populations that are often most at risk. These clinics serve over eight percent of the state's population, nearly three million people, during a typical year. One in every eight children receives health care services through community clinics as does one in seven of the state's Latino population. Not surprisingly a fifth of the uninsured population seeks care in these clinics, but almost the same number of those insured through Medi-Cal also seek care through community clinics.
Community clinics represent more than this vital safety net. They also represent a different way to organize and deliver services and an approach to care which has a different set of values and orientation than the rest of the dominant health system.
Perhaps most importantly these clinics are integrated into and often are expressions of the communities they serve. Cultural competence comes more easily here because the clinics live in the communities, they do not provide medical care at isolated and disconnected locations. This means the care is created in a way that values the communities served, but also uses the communities to promote health, reinforce therapeutic interventions and draw new expertise and knowledge directly from the wisdom of the community members. Many people believe that a more community-based approach to care, particularly when addressing chronic disease and disability, is essentially the only way to provide cost effective quality care. The community clinics through design and necessity have been approaching care in such a manner for years.
The clinics also maintain a radical focus on the population served and act to integrate resources from a great variety of sources to meet the needs of individuals, groups and communities. This has also been borne out of necessity, but it represents a different approach from the way the broader health system is structured. Because resources are scarce it is important to derive as many benefits as possible from primary prevention, without worry as to whether or not the payoff will accrue to the care delivery organization. Community clinics will be providing care for their population, so investments in prevention are returned monetarily and improve health conditions. But the other reason for the success of focusing on the population is that there are not different institutions competing for their share of the health care resources, rather the clinics act to integrate the resources where they will provide the greatest benefit.
While clinics are financed in part from public and private insurance, which some of their patients and customers hold, the actual operation of the clinics as a single care delivery organization maintains a budget, employs clinical and non-clinical workers to provide care and raises money to do so from a combination of insurance payments, fees, grants and other fund raising activity. While this approach is more precarious, it also presents some flexibility and adaptability which the other health system cannot seem to muster. Because the dominant health system is captured by the insurance benefit and what is in it or not, what is billable or not, it presents the hazard of only focusing on what is to be paid for directly.
As not-for-profit, community-based organizations for the delivery of a broad set of health care services, the community clinics may not only represent a vital part of the safety net for at risk populations, they may in fact be a model for those who are looking for new ways of organizing the way care is delivered to other populations.
This fall the Center for the Health Professions with support from the Blue Shield Foundation of California is designing a leadership development program for emerging leaders in California's community clinics. We are excited about this opportunity to assist these institutions as they face the challenges of the future and redirect themselves to new problems and issues.
Check the Center's website for more details on this initiative over the next few months.