Community health care centers and rural health clinics are underprepared to properly deal with a jump in demand for primary care services and increased patient load brought on by the Affordable Care Act, according to a recent study published by the University of Iowa Public Policy Center and College of Public Health.
About 25 million individuals are expected to gain insurance coverage over the next five years through the Affordable Care Act. At the same time, as many as 31 million individuals will remain uninsured.
“We wanted to address the misconception that, with health reform, there isn’t as much of a need for safety-net services,” said Brad Wright, an assistant professor in the Department of Health Management and Policy at the College of Public Health and one of the study’s authors.
Safety net providers will have to provide a significant amount of care to help meet the increased demand for primary care services, but data shows both community health care centers and rural health clinics are not fully staffed, have difficulty recruiting professionals to fill vacant positions, and report challenges referring patients for specialty care.
“Concerns about the capacity and long-term sustainability of CHCs and RHCs are not new, but the nature of the concerns is changing,” the study said. “Now the concern is that the number of insured people is outpacing the ability of the entire health care system — including safety net providers — to care for them.”
The Public Policy Center sent out an online survey to 13 community health care centers and 142 rural health clinics in Iowa, asking the centers about staffing levels, recruitment efforts and future staffing needs. Centers were also asked to predict how the ACA will change their patient load.
“(The centers) have a lot of vacancies that they’re trying to fill but are having issues,” Wright said. “This is not necessarily news as much as a perpetual issue.”
Community health care centers said they struggle recruiting mental health professionals, social workers and physicians because of funding constraints as well as trouble offering competitive salaries. Meanwhile, rural health clinics reported having trouble recruiting physicians, nurse practitioners, and physicians assistants, which the survey found was because of the rural location, inadequate salaries, and lack of loan forgiveness for newly licensed physicians.
Because of the staffing problems, these health care centers also have trouble providing adequate care, the survey found. For instance, only 73 percent consider their ability to provide family medicine services adequate, while one-third of CHCs consider their ability to provide surgical services less than adequate.
And the study indicates the need for safety net providers is only going to increase.
About 73 percent of community health care centers and 59 percent of rural health clinics are preparing for an increase in their patient population, with 27.3 percent and 14.8 expecting a substantial increase, respectively.
“There’s not only going to be an increase in patients, but an increase in visits among those people,” Wright said.
The study did not ask the health care centers about strategies they may use to address these issues, Wright said, but the Public Policy Center plans to look into that in the future.