Dental Care Insurance Primary Care Safety Net Clinics

Access Indicators: Safety Net Clinics

The current supply of safety net clinics only meets 36% of the demand for health care by the working poor. There are nearly 1.5 million people in the nine-county region who are uninsured at any given time, and it is estimated that they need approximately 4.2 million visits. More below…

FIGURE-34_Location of region's safety net clinics

This population relies on safety net providers—a loose network of public and private nonprofit clinics—to meet their primary care needs. There are only enough safety net clinics in the region to meet 36% of the demand. People who cannot get care in the safety net end up seeking care in emergency rooms and private clinics, or they and their children do without care. The map on this page shows the location and types of safety net primary care clinics across the eight-county region. They offer a broad spectrum of health care services to adults and children in community and school-based settings. There are 144 safety net clinics in our region, including 105 in Harris County (78%) and 39 in the other seven counties. Comparing safety net system capacity among cities is difficult, as their composition varies widely. But data on Federally Qualified Health Centers (FQHCs), a common safety net component responsible for about 24% of the 1.5 million primary care visits, can be examined. Data gathered by the Health Resources and Services Administration show the percentage of the working poor served by FQHCs in several cities, and reveal that Houston is seriously lagging other cities, except Dallas.

FQHCs have been a significant part of the national health care delivery system for almost 50 years, yet this region did not take advantage of this program until recently. Harris County organized its first FQHC in 1994, obtaining a second one only in 2004.

At the request of the Center for Houston’s Future, Dr. Charles Begley, of UT School of Public Health, and Dr. Jeanne Hanks, of St. Luke’s Episcopal Health Charities, conducted ground-breaking work to determine the gap between the supply and demand for primary care clinics among the working poor in the eight-county region. They projected the future gap between supply and demand following full implementation of the Affordable Care Act (ACA).

The study found that in 2012, there was enough capacity/supply to serve 36% of the primary care demand of the working poor through safety net clinics. However, as the ACA is fully implemented, demand will increase as more working poor gain access to insurance. If demand increases by 11%-14%, and there is no growth in clinic supply, the proportion of primary care met by safety net clinics will be reduced from 36% to 31%-33%. The study concluded that the remaining demand will have to be met by increased capacity among private practice, non-safety net providers — including hospital emergency rooms — or people will go without primary care (Begley et al., 2012).

The safety net capacity graph on this page shows that, with the exception of Chambers County, most counties in the region experience a supply gap for safety net providers of 60%-plus. This gap is expected to increase given two different ACA scenarios (Begley et al., 2012). Failure to meet the increased demand for primary care through expansion in safety net and private-practice primary care capacity is likely to further burden our already overtaxed emergency room facilities.

Source cited

Begley C., Hanks J., Le P., “The Need for Safety Net Primary Care in the Greater Houston Area,” Center for Houston’s Future, August 2012.