Get reimbursed for COVID-19 testing and treatment of uninsured individuals.     Learn more »

The Global Health Care Crunch

Yse' Massot (left) and Celine Jaeggy visited HRSA from the Embassy of France on Dec. 20 for a briefing on the Health Center Program. Faced with a burgeoning elderly population, health workforce shortages and scant services in many rural areas, France is considering alternative delivery models.
Yse' Massot (left) and Celine Jaeggy visited HRSA from the Embassy of France on Dec. 20 for a briefing on the Health Center Program. Faced with a burgeoning elderly population, health workforce shortages and scant services in many rural areas, France is considering alternative delivery models.

 

Tonya Bowers, Deputy Associate Administrator of the Bureau of Primary Health Care, told French health officials last month that the U.S. health center population has more than doubled to 28.4 million people since the administration of  President George W. Bush, and the number of health center locations has more than tripled to some 12,000.
Tonya Bowers, Deputy Associate Administrator of the Bureau of Primary Health Care, told French health officials last month that the U.S. health center population has more than doubled to 28.4 million people since the administration of  President George W. Bush, and the number of health center locations has more than tripled to some 12,000.

 

But despite strong bipartisan support for the program and an overall growth rate of 176 percent since 2001, health services in U.S. rural areas remain "fragile." And demand for new health center clinics is overwhelming.

"We always get more applications than we can fund," Bowers told Celine Jaeggy of the French embassy's office of Labor, Health and Social Welfare, which requested the meeting with HRSA staff. Bowers noted that only one of about every six proposals for 500 new health center sites got agency financing in a recent grant competition.

The pent up demand, experts say, is an increasingly familiar phenomenon worldwide.

The World Health Organization has repeatedly warned of the global trend now affecting France, whose health care system consistently ranks among the best in the developed world: "Physicians are getting older," the world health authority has reported HRSA Exit Disclaimer. "Nearly one out of three physicians (in Europe) is more than 55 years old."

In France, that has translated to hundreds of rural and small town doctors retiring and closing their practices -- in the face of an upsurge in elderly patients with chronic conditions and few local health care alternatives. Solving the shortage problem has become a top priority for the administration of French President Emmanuel Macron.

 

LCDR Charlie Darr, Acting Deputy Director of HRSA's Office of Global Health, hosted the French delegation.
LCDR Charlie Darr, Acting Deputy Director of HRSA's Office of Global Health, hosted the French delegation. The visitors were among dozens in recent years  seeking insight into agency programs that help high-need communities. In the face of worldwide care shortages -- especially in rural regions -- the 53-year-old health center program represents a model that works.

 

Health centers have helped cut costs to the healthcare system by reducing hospital admissions and the need for specialty care; lowering primary care costs; and exceeding national averages in hypertension and diabetes outcomes. 

Bowers stressed that the movement toward "team-based, patient-centered care," health information technology, and electronic health records has made for a more efficient system for providers and patients alike. Still, the U.S. is facing a projected shortage of almost 24,000 primary care doctors and more than 15,000 dentists over the next five years, HRSA Administrator Tom Engels observed in a recent address to a HRSA workforce advisory group.

"Health centers would say that (maintaining) the workforce is their number one challenge," Bowers told the French delegation.

 

BHW's Dr. Luis Padilla reported to a workforce advisory group on Jan. 8 that HRSA's National Health Service Corps currently has an all-time high of 13,000 clinicians in the field -- one third of them in rural communities and almost 60 percent practicing in health centers -- but the patient base increasingly is composed of elderly, chronically ill Americans.
BHW's Dr. Luis Padilla reported to a workforce advisory group on Jan. 8 that HRSA's National Health Service Corps currently has an all-time high of 13,000 clinicians in the field -- one third of them in rural communities and almost 60 percent practicing in health centers -- but the patient base increasingly is composed of elderly, chronically ill Americans. 
 

"As a backdrop here, what we're facing is the migration of our population from rural areas to urban areas," Dr. Luis Padilla, BHW Associate Administrator, told the advisory group, "and that is not changing anytime soon. So we have an ever-decreasing population in our rural areas, and they're older" --  which often makes new health centers harder to sustain financially, and harder to staff, for lack of a sufficient patient base.

In a pattern now playing out around the world, 119 small rural hospitals in the U.S. have closed their doors in recent years, leaving over 170 U.S. counties with no health center or hospital, according to HRSA's Federal Office of Rural Health Policy. There are currently more than 20,000 designated shortage areas nationwide.

"There are millions and millions of people that don't have access to care, even in this country," Bowers told the French delegation. "They may go occasionally (for distant care) when they have a real crisis, but they're not getting the (preventive) care that they need."

Care scarcity has been documented in countries as diverse as Japan, Singapore, China, Germany, the U.K. and Australia. As the post-World War II generation of clinicians retire, the global population of aging, chronically ill, Baby Boom patients is steadily rising.

One result has been a trend of rural dwellers moving into major cities and further taxing already strained urban health care workforces.

Echoing concerns of her counterparts in Europe, the Pacific Rim and elsewhere, HRSA's Dr. Torey Mack of the Bureau of Health Workforce warned a conference of health center executives last month that the costs of "clinician burnout" -- occupational illnesses, lost days of work, mental health issues and early retirements -- already are mounting and could be as much as $6.3 billion per year in the U.S. alone.

The problem is "highly prevalent" among French physicians, as well, researchers there recently reported.

Date Last Reviewed:  January 2020