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Revisiting ‘The Clinic’: ethical and policy challenges in US community health centers

Published online by Cambridge University Press:  20 May 2014

Nancy Berlinger ,
Michael K. Gusmano  and
Eva Turbiner
Nancy Berlinger
Affiliation:
Research Scholar, The Hastings Center, USA
Michael K. Gusmano*
Affiliation:
Research Scholar, The Hastings Center, USA
Eva Turbiner
Affiliation:
President & CEO, Zufall Health Center, USA
*
*Correspondence to: Michael Gusmano, 21 Malcolm Gordon Road, Garrison, NY 10524, USA. Email: gusmanom@thehastingscenter.org
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Abstract

Where do poor people in the United States (US) go when they get sick? Often, they go to Federally Qualified Health Centers (FQHCs) and hospital emergency departments. Even after the implementation of the Patient Protection and Affordable Care Act (ACA), these safety-net health care organizations will continue to play a crucial role in the US health care system. FQHCs have long grappled with some of the biggest questions facing the US health care system and their leaders and clinicians face ethical challenges in everyday practice. Ethical and policy challenges in the US health care safety-net are not usually ‘tragic choices’ involving the allocation of transplantable organs, or ventilators during a pandemic. They are everyday choices with a tragic dimension because, even with the adoption of the ACA, the US has not yet decided whether poor people deserve a ‘home’ or a ‘net’ when they are sick, and whether even a net should be in good repair.

Type
Perspective
Information
Health Economics, Policy and Law , Volume 9 , Issue 4 , October 2014 , pp. 425 - 434
Copyright
© Cambridge University Press 2014 

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References

Berlinger, N. and Gusmano, M. K. (2011), ‘Undocumented Patients and Access to Health Care: Project Overview’, www.undocumentedpatients.org [16 April 2014].Google Scholar
Bisgaier, J. and Rhodes, K. V. (2011), ‘Auditing access to specialty care for children with public insurance’, New England Journal of Medicine, 364(24): 2324–2333.CrossRefGoogle ScholarPubMed
Council on Graduate Medical Education (2010), ‘Advancing primary care’, Chicago: Council on Graduate Medical Education: Twentieth Report, December, http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentiethreport.pdf [16 April 2014].Google Scholar
Draper, D. A. (2011), ‘Hospital emergency departments: health center strategies that may help reduce their use’, testimony before the Subcommittee on Primary Health and Aging, Committee on Health, Education, Labor, and Pensions, US Senate, Government Accountability Office, Washington, DC, pp. 2–4, http://www.gao.gov/new.items/d11643t.pdf [16 April 2014].Google Scholar
Gusmano, M. K., Fairbrother, G. and Park, H. (2002), ‘Exploring the limits of the safety-net: community health centers and care for the uninsured’, Health Affairs, 21(6): 188–194.CrossRefGoogle ScholarPubMed
Lenihan, M. (2009), ‘Clearing the fog: achieving reasonable public disclosure of available free and reduced cost health care in Galveston County, Texas’, Boston, Community Catalyst, November, http://www.communitycatalyst.org/doc_store/publications/Clearing_the_Fog.pdf [16 April 2014].Google Scholar
Pearson, S. D., Sabin, J. E. and Emanuel, E. J. (2003), No Margin, No Mission: Health-Care Organizations and the Quest for Ethical Excellence, Oxford: New York. p 98.CrossRefGoogle Scholar
Pryor, C., Rukavina, M., Hoffman, A. and Lee, A. (2010), ‘Best kept secrets: are non-profit hospitals informing patients about charity care programs?’, Boston, The Access Project and Community Catalyst, http://www.communitycatalyst.org/doc_store/publications/Best_Kept_Secrets_May_2010.pdf [16 April 2014].Google Scholar
Ku, L., Richard, P., Dor, A., Tan, E., Shin, P. and Rosenbaum, S. (2010), ‘Strengthening primary care to bend the cost curve: the expansion of community health centers though health reform’, Geiger Gibson/RCHN Community Health Foundation Research Collaborative, Policy Research Brief No. 19, 30 June, New York.Google Scholar
Mullan, F. (2009), ‘Health care workforce issues and access to care: assessing the present and preparing for the future’, testimony before the House Energy and Commerce Subcommittee on Health, 24 March, Washington, DC.Google Scholar
Naylor, M. D. and Kurtzman, E. T. (2010), ‘The role of nurse practitioners in reinventing primary care’, Health Affairs, 29(5): 893–899.CrossRefGoogle ScholarPubMed
Rosenbaum, S., Zakheim, M. H., Leifer, J. C., Golde, M. D., Schulte, J. M. and Margulies, R. (2011), ‘Assessing and addressing legal barriers to the clinical integration of community health centers and other community providers’, The Commonwealth Fund, July, New York.Google Scholar
Sabin, J. (2009), ‘Tragic choices at Grady Hospital’, Health Care Organizational Ethics, 29 December, http://healthcareorganizationalethics.blogspot.com/2009/12/tragic-choices-at-grady-hospital.html [9 March 2014].Google Scholar
Silow-Carroll, S. and Alteras, T. (2004), ‘Stretching state health care dollars: innovative use of uncompensated care funds’, Commonwealth Fund Report #784, October, New York.Google Scholar
Thompson, F. J. and Gusmano, M. K. (2014), ‘The Administrative Presidency and Fractions Federalism: The Case of Obamacare’, Publius: The Journal of Federalism, doi: 10.1093/publius/pju011: 1–25.Google Scholar