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The community health center (CHC) in the United States is the dominant model for federal grant funding for primary care in the country's health care safety net. The U.S. safety net consists of health care professionals willing to provide services to the nation’s uninsured and underserved population.〔 Taylor, J. (2004). ''The fundamentals of community health centers.'' Washington, DC: The George Washington University.〕 According to the U.S. Census Bureau, 50.7 million people in the country (16.7% of the population) were uninsured in 2009.〔DeNavas-Walt C., Proctor B.D., Lee C.H. (2010).''Income, Poverty, and Health Insurance Coverage in the United States: 2009.'' Washington, DC: U.S.Government Printing Office.〕 Many more Americans lack adequate coverage or access to health care. To receive health care services, this group of people must use providers who are either personally chosen or are legally required to provide care despite the patients being unable to pay. CHCs represent a provider group for this group. CHCs are organized as non-profit clinical care providers that operate under comprehensive federal standards.〔Kaiser Commission on Medicaid and the Uninsured. (2010, September 13). ''Community health centers: Opportunities and challenges of health reform.'' Retrieved from http://www.kff.org/uninsured/upload/8098.pdf 〕 The two types of clinics that meet CHC requirements are those that receive federal funding under Section 330 of the Public Health Service Act and those that meet all requirements applicable to federally funded health centers and are supported through state and local grants.〔Kaiser Commission on Medicaid and the Uninsured. (2009, March). ''Community health centers.'' Retrieved from http://www.kff.org/uninsured/upload/7877.pdf〕 Both types of CHCs are designated as “Federally Qualified Health Centers” (FQHCs), which grants them special payment rates under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). To receive Section 330 grant funds, CHCs must meet the following qualifications:()() : *Be located in a federally designated medically under-served area (MUA) or serve medically under-served populations (MUP) : *Provide comprehensive primary care : *Adjust charges for health services on a sliding fee schedule according to patient income : *Be governed by a community board of which a majority of members are patients at the CHC Uniquely in community health centers, at least 51% of all governing board members must be patients there. A sliding fee scale based on income is implemented to decrease the cost of care. The purpose of these stipulations is to ensure that health centers improve access to care and serve the community. Integration of health care services is a major focus. Administrative and health care personnel meet regularly to focus on location health care needs. Services are provided that vary depending upon the site including primary care, dental care, counseling services, women's health, health promotion and education, podiatry, physiotherapy, case management, advocacy and intervention. The mission of community health centers depends on collaborative relationships with industry, government, hospitals and other health services. Community health centers that receive federal funding through the Health Resources and Services Administration, HHS, are also called "Federally Qualified Health Centers." There are now more than 1,250 federally supported FQHCs with more than 8,000 service delivery sites. They are community health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers that deliver primary and preventive health care to more than 20 million people in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. == History == According to historian John Duffy, the concept of community health centers in the United States can be traced to infant milk stations in New York City in 1901. In November, 1914, the city established the first district health center in New York at 206 Madison Avenue, serving 35,000 residents of Manhattan's lower east side. The staff consisted of one medical inspector and three nurses stationed permanently in the district who, through a house card system, developed a complete health record of each family.〔 Duffy, J. (1974). ''A history of public health in New York City 1866-1966.'' New York: Russell Sage Foundation. 〕 In 1915, the system expanded, adding four district centers in Queens. Wartime and political pressures ended this development in New York City, but privately funded clinics through the New York Association for Improving the Condition of the Poor were started in 1916 (Bowling Green Neighborhood Association), 1917 (Columbus Hill Health Center), 1918 (Mulberry Street Health Center) and 1921 (Judson Health Center). Founded by Eleanor A. Campbell in Greenwich Village, the Judson Health Center became the largest health center in the U.S. by 1924. The official establishment of community health centers was caused by the civil rights movement of the 1960s. The Office of Economic Opportunity (OEO) established what was initially called “neighborhood health centers” as a War on Poverty demonstration program.() The aim of these clinics was to provide access points to health and social services to medically under-served and disenfranchised populations. The health centers were intended to serve as a mechanism for community empowerment. Accordingly, federal funds for the clinics went directly to nonprofit, community-level organizations. () The health centers were designed and run with extensive community involvement to ensure that they remained responsive to community needs. Under the modern definition, the first community health center in the United States was the Columbia Point Health Center in Dorchester, Massachusetts, which opened in December 1965. The center was founded by two medical doctors - H. Jack Geiger, who had been on the faculty of Harvard University and later at Tufts University, and Count Gibson, also from Tufts University.〔(Delta Health Center Records, 1966-1987 ) in the Southern Historical Collection at the University of North Carolina at Chapel Hill.〕〔Sargent Shriver, ("Remarks of Mr. Shriver at Comprehensive Health Services Press Conference. June 1, 1967" ).〕〔(Dr. Count Gibson's biography at George Washington University, School of Public Health and Health Services )〕 Geiger had previously studied the first community health centers and the principles of community-oriented primary care with Sidney Kark 〔Brown, T.M., and Fee, E. (2002). (Voice from the past: Sidney Kark and John Cassel: Social medicine pioneers and South African Emigrés ). ''American Journal of Public Health, 92''(11), 1744-1745.〕 and colleagues while serving as a medical student in rural Natal, South Africa.〔(Dr. Jack Geiger's biography page at George Washington University, School of Public Health and Health Services )〕 The federal government's Office of Economic Opportunity (OEO) funded the Columbia Point Health Center, which served the poor community living in the Columbia Point Public Housing Projects located on an isolated peninsula far away from Boston City Hospital.〔Roessner, J. (2000). ''A decent place to live: From Columbia Point to Harbor Point - A community history.'' Boston: Northeastern University Press.〕 On its twenty-fifth anniversary in 1990, the center was rededicated as the Geiger-Gibson Community Health Center and is still in operation.() At about the same time, Geiger and Gibson also established a rural community health center, the Delta Health Center, in Mound Bayou, Bolivar County, Mississippi to serve the poverty-stricken counties of Bolivar, Coahoma, Sunflower, and Washington.〔Chu, C. (2006). Out in the rural: A health center in Mississippi. ''Social Medicine, 1''(2).〕〔UNC University Libraries. ''Delta Health Center records, 1956-1992.'' Retrieved from http://www.lib.unc.edu/mss/inv/d/Delta_Health_Center.html〕 This center was also set up in conjunction with Tufts University with a grant from the OEO. While the Columbia Point Health Center was set in an urban community, the Delta Health Center represented a rural model. In the early 1970s, the health centers program was transferred to the Department of Health, Education, and Welfare (HEW). The HEW has since become the U.S. Department of Health and Human Services (HHS). Within HHS, the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) currently administers the program.() 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Community health centers in the United States」の詳細全文を読む スポンサード リンク
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