community health centers

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Economic Abuse: Recognizing It In The Doctor’s Office And Beyond

By Dr. Paul Mendis
Guest contributor

Sarah’s husband was not only the primary earner in the household, but he also controlled the family’s finances. In addition to physically abusing her, he would withhold Sarah’s “allowance” so that she and their children could not afford the co-payment to see a doctor and get the health care they needed.

Unbeknownst to Wendy, her partner amassed hundreds of thousands of dollars in credit card debt in her name. After their breakup, she learned that she had no legal way of addressing the fraud, and became responsible for repaying the debt that he had accumulated. The stress of paying off this debt took a disproportionate toll on her health, and she developed chronic fatigue syndrome, as well as anxiety and sleep-related disorders.

Stay-at-home mom Janine (all names have been changed) was dependent on her husband’s health insurance for her own care, and the care of her young, chronically ill daughter. Janine did not have any savings, nor was she able to train for a job while taking care of a sick child. Although Janine’s husband was verbally and emotionally abusive to both of them, she was forced to stay in the relationship to ensure that her daughter had access to health care.

These are just some of the stories about Americans who experience economic abuse, a form of domestic abuse that is not just a criminal justice issue; it is very much a health care issue.

Dr Paul Mendis (NHP)

Dr Paul Mendis (NHP)

Some background: Economic abuse is a serious, and often overlooked, form of domestic violence, which can leave a partner completely dependent on an abuser to supply basic needs. An abuser will control a partner’s finances and prevent him or her from accessing resources, maintaining control of earnings, and gaining financial independence. The abuser may also interfere with a significant other’s work performance or prevent education, job training, and the ability to find and keep a job.

Typically, economic abuse goes hand-in-hand with domestic violence, which is experienced by one in four women in their lifetime. We usually associate domestic violence with physical or verbal abuse, but economic abuse is just as significant and can have long-lasting and devastating effects. The National Coalition Against Domestic Violence reports that over 1.75 million workdays are missed each year as a result of absenteeism, decreased productivity, and health and safety costs associated with domestic violence.

Economic abuse can also affect a victim’s access to health care and medicine. A victim of abuse may resist leaving an abusive partner because his or her children are dependent on that partner’s health insurance. Additionally, the victim may avoid medical care altogether because transportation options have been withheld or limited, or because he or she cannot afford co-payments while a partner controls the finances.

Victims of domestic violence may not seek out necessary health care services for fear of revealing an abusive situation to medical professionals. This is especially true when an abuser is the primary policy holder on the family’s health insurance. In most cases, the victim does not want a partner to know that he or she is accessing health care because it can escalate the violence at home.

Therefore, physicians may not always see victims with acute, trauma-related injuries, but rather, other serious health issues that require treatment. For example, victims experience toxic stress that can manifest as chronic health conditions, like heart disease or a worsening of asthma. Economic abuse can have a long-lasting impact on a victim’s health and well-being — even after an abusive relationship is over.

It is important to remember that economic abuse, like other forms of domestic violence, can happen to anyone, regardless of age, race, gender, sexual orientation, marital status, or income. Continue reading

Feds Grant $33M To Community Health Centers In Mass.

Health and Human Services Secretary Kathleen Sebelius today announced $33,716,628 in grants awarded to community health centers around the state for renovation and new construction projects under the new health care law, the Affordable Care Act. The agency noted that “these awards will help them serve approximately 42,539 new patients,” according to estimates from the grantees.

From HHS:

The announcement made today is for awards from two capital programs for community health centers. One will provide approximately $629 million to 171 existing health centers across the country for longer-term projects to expand their facilities, improve existing services, and serve more patients. This program will expand access to an additional 860,000 patients. The second set of awards will provide approximately $99.3 million to 227 existing health centers to address pressing facility and equipment needs. Continue reading

With Health Reform, An Increased Demand For Safety-Net Hospitals, Study Finds

It’s always good to get an outsider’s perspective.

So, with that in mind, here’s a new study with findings that are no surprise to health policy types in Massachusetts, but may be notable to everyone else, including the researchers from Washington, D.C. and elsewhere who carried out the analysis. Published today in the Archives of Internal Medicine, the study found that even after the Massachusetts health reform law and a spike in the number of people with health insurance, patients still chose to get care at safety-net hospitals and community health centers. Most people surveyed said they continued to seek care at these hospitals and health centers because they were convenient and affordable or provided important, non-medical services.

Why do patients stick with safety-net hospitals?

The study concludes: “Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise…Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.”

Study author Leighton Ku, Ph.D., M.P.H., from George Washington University, Washington, D.C., explains that some people thought that once patients got an insurance card, they’d flee the safety-net hospitals. “You might think that the newly insured would choose to go to the MGHs not the Boston Medical Centers, the private doctors in Back Bay, not the community health centers…but that is not what we found.” Continue reading

Community Health Centers, Serving The Poor, Get Federal Money Under Reform Law

Codman Square is one of eight community health centers that received federal money under the new health reform law

Eight community health centers, located in some of the poorest communities in the state, have received $43 million from the federal government to upgrade their buildings or pay for new construction under the national health reform law, The Boston Globe reports.

(Earlier this year, eight other community health centers in Massachusetts received $80 million for technology and other upgrades under the federal stimulus package.)

The new round of funding, announced today by the U.S. Department of Health and Human Services will help clinics that are frequently the key providers of primary care in the community. The recipients are:

–Community Health Center of Cape Cod, Mashpee: $6 million
–Edward M. Kennedy Health Center (formerly Great Brook Valley Health Center), Worcester: $6.4 million
–Codman Square Health Center, Dorchester: $7.95 million
–Brockton Neighborhood Health Center: $11.35 million
–Outer Cape Health Services, Wellfleet: $3.62 million
–Lynn Community Health Center: $6.94 million
–North Shore Community Health, Salem: $750,000
–Duffy Health Center, Hyannis: $461,991