Health center serves one-third of a four-county area in rural Texas

Eighty miles west of San Antonio, Community Health Development Inc., based in Uvalde, has operated for 20 years, serving 10,000 people or one-third of the population of a four-county area through three service sites.

Center CEO Rachel Gonzales-Hanson tells State Health Watch her center provides a full array of integrated comprehensive health care services including medical, with OB care; dental; laboratory; X-ray; pharmacy; health education; and preventive care screenings. Providers are board-certified physicians.

The population served is 65% Hispanic and 30% Caucasian, with the remainder from Asia and the Philippines and Native Americans. The vast majority of those who come to the center are below the 185% poverty line.

According to Ms. Gonzales-Hanson, in 2003, the center saw 15% to 18% of its clients with Medicaid, 20% with Medicare, 5% with private insurance, and the rest with no health insurance coverage. She says the center uses whatever third-party revenues it is able to receive to provide services to those who aren’t covered.

"If we weren’t here, some of our patients would go to Mexico for care, while most would wait until they faced a very bad health situation and then would go to the hospital emergency room. They would wait until it was really bad because of the cost and also the way they are treated there. A few patients might be willing to go to San Antonio, but they probably wouldn’t have any transportation to get there.

"We provide a lot of value-added services," she tells SHW. "Preventive care is a very strong focus, along with health education. Services are provided whether there is coverage for them or not. We are in a group purchasing program for pharmaceuticals and pass the savings along to our patients."

Asked if she has sufficient funding, Ms. Gonzales-Hanson candidly acknowledges she has been fortunate to receive some additional grand funds on top of her federal funding, making her an exception to the general rule among community health center executives. Even so, for a 10-year period, her center received no additional funding although its costs increased considerably.

"Some members of our staff qualify for Medicaid," she says. "That’s simply not right, but it’s the way things are. People often believe that it’s cheaper to provide health care in rural areas, but that is a myth. We’ve just learned to do more with less."

Asked to make the case for more funding for community health centers, Ms. Gonzales-Hanson ticks off three points:

  1. There is a need for people to have a medical home, particularly in rural areas. Two of the counties served by her center have no retail pharmacy in them and the center is the source of prescription drugs for its patients. "There is no other model in the United States that can do what we do and has the track record we have in terms of cost and quality," she says.
  2. Rural people shouldn’t be punished for where they live. "There’s a lot of important work that is done in rural areas, and they [workers] need health care as much as anyone else. We are a great solution for that and sometimes the only solution."
  3. Health centers are cost-effective and also valuable because of the local control of the board of directors. The community decides the services that are needed and how they should be provided. The board has to have at least 51% of patients from the center. And the centers are an amazing economic stimulus in their communities.

[Contact Ms. Gonzales-Hanson at (830) 278-5604, ext. 200.]