Evaluation of OEO neighborhood health centers

Impact of federal primary health care policy in rural areas: empirical evidence from the literature

This review examines the equity, efficiency and effectiveness of federal rural primary care policy as documented by the existing literature. The focus is on the Community Health Center and National Health Service Corps programs which have constituted the major components of the policy. The literature relating to the policy is limited in the number of studies available and in the quality of the research. The available evidence indicates that the policy is associated with an improvement in the distribution of health resources between rural and urban areas,and among rural areas. There is also partial evidence that the policy has been cost-efficient. For federally subsidized practices,the cost of delivering a similar quality of health care is shown to be up to 50 percent less in rural than in urban areas. Rural private practitioners, though, may be more cost-efficient than federally subsidized rural practitioners, at least under certain conditions which have yet to be fully delineated. Program effectiveness is the least well documented, but the literature does suggest that the policy has had a positive effect on the health status of rural populations. Substantially more research on the efficiency, and particular the effectiveness, of federal rural primary care policy is required for the development of a rational basis for the policy.

Health services as a defence against the consequences of poverty in industrialised societies

The purpose of this paper is to offer, as a basis for discussion, a review of the issues involved in a consideration of the role of health services as a 'defence' against the consequences of poverty. First, some general questions are asked: It is true that industrialised nations have reached a stage of development where health care is irrelevant to health? Is the issue inequality in health, or more narrowly the particular problems of a minority, the 'poor'? Are the causes of disadvantage in health to be seen as behavioural or structural, and if health systems concern themselves with social-structural issues, is this medical imperialism or the proper exercise of responsibility? The role of health services is considered in relation to primary prevention, secondary prevention (or curative medicine) and tertiary prevention (or rehabilitative medicine). It is concluded that (though the impact of any form of universally-available health service must not be minimised) health systems in industrialised societies are not in general successful in mitigating or preventing the health problems of poverty. Some socio-medical policy programmes and some health-care delivery initiatives have, however, produced measurable effects. It is suggested that, while health systems can never wholly compensate for social inequalities in health, 'community' programmes may perhaps most effectively combine the structural and the individual approaches.

Analysis of the reasons for the high turnover of clinicians in neighborhood health centers

A high rate of turnover of professional personnel in a clinic is disruptive to patient care and organizational stability as well as to the individual clinician. The turnover rate for clinicians (physicians, nurse practitioners, and physician assistants) working in neighborhood health centers (NHCs) is considerably higher than that for clinicians in other forms of practices. All 10 of the neighborhood health centers in HEW (Department of Health, Education, and Welfare--now the Department of Health and Human Services) Region X (Alaska, Idaho, Washington, and Oregon) that offered a full range of medical services provided information about the clinicians that they had employed since their inception. One hundred and one clinicians were surveyed about their work experience. The vast majority of those clinicians who had left a neighborhood health center remained in the community; they cited organizational issues as being at the heart of their dissatisfaction with the centers. Clinicians who began work during the initiation of a clinic remained significantly longer. The results suggest the immediate need for a strategy directed at the smooth organizational evolution of each NHC right from its inception.

Evaluating a primary care clinic in a local health department

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