PCMS_Philadelphia_Medicine_Summer2017 - 24

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Feature

Health Centers
Moving from the Past
to the Future
By: Drs., Susan Robbins and Walter Tsou

Creating Health Centers
Back in the 1960s traditional public health clinics dotted the country.
Clinic services were limited to well-baby checkups, immunizations,
TB or STD services. The latter two services always carried a stigma
for those brave enough to walk through the doors. Parents of sick
kids were told to see their children's doctor or go to an emergency
room, even though the well-baby checkup was performed by a fully
trained pediatrician.
Despite the growing number of poor families, organized medicine
was strongly opposed to public health clinics that would compete
against private practices. Those who wanted basic primary care services
went to private doctors. Those with limited income were often seen
through the generosity of doctors on a sliding scale.

In the mid 1970s, the Philadelphia Evening Bulletin published a
series of scathing articles about the city's public hospital, Philadelphia
General Hospital (PGH). Mayor Frank Rizzo used these articles to
close PGH, relieving the city of a huge financial burden. Naturally,
there was a huge protest by the PGH staff. Mayor Rizzo promised
that the city was not abandoning health care for the poor, and said
that all Philadelphia residents could receive outpatient services
through the city health centers.
The popularity and success of HC #5 along with Mayor Rizzo's
promise created the impetus to convert the Philadelphia public
health clinics into eight comprehensive health centers which were
eventually completed over a dozen years.

Health Centers Today

Today, people in Philadelphia are quite fortunate in being able to
As an outgrowth of President Lyndon Johnson's Great Society,
receive
generally excellent primary care at more than 40 community
new models of health care delivery were being tried like Community
health
centers,
including eight FQHC "look-alike" centers that are
Oriented Primary Care where traditional public health services were
operated
by
the
Philadelphia Department of Public Health (PDPH).
combined into a primary care health center, and teams of public health
These
PDPH
centers,
scattered throughout the City, are administered
nurses were geographically assigned neighborhoods surrounding the
through
the
Ambulatory
Health Services (AHS) Division of PDPH.
health center. In Philadelphia, the first experimental model was at
Health Center (HC) #5 in the middle of North Philadelphia. Staff back
Each year more than 300,000 visits are made to the eight PDPH
then sang high praises for this model that even offered occupational
sites
by residents of the city. The centers care for both the insured
therapy within the center. Public health nurses walked through the
and
uninsured.
Those without insurance do pay a small fee for each
neighborhoods in their white caps weighing babies and handling all
visit
based
on
a
sliding
scale, but receive, without additional charges, a
kinds of community problems. Those who needed more care were
wide
variety
of
services
and even medications that are on an approved
referred back to HC #5. Unfortunately, as the money tightened,
formulary.
Uninsured
patients are encouraged to apply for health
services were cut, including the public heath nurses who were spun
insurance,
and
may
do
so with the assistance of benefit counselors
off and merged into the Visiting Nurse Associations.
available at each site. Once insured, many remain as patients at the
site for ongoing care.

24 Philadelphia Medicine : Summer 2017
https://philamedsoc.org/
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