Executive Summary

National Health Service Corps

The National Health Service Corps (NHSC) is committed to improving the health of the Nation's underserved by uniting communities in need with caring health professionals and supporting those communities' efforts to build better systems of care.

The National Health Service Corps (NHSC) was created in 1970 to improve health care for the underserved in areas of critical need.  Designed to provide comprehensive health care that bridges geographic, financial, cultural and language barriers, the NHSC works to unite communities in need with caring health professionals, then supports those communities’ efforts to build better systems of care.

Underserved areas have been particularly vulnerable to losing access to primary care due to a number of concurrent trends, including an increase in physician specialization, an increase in centralization of health care providers, and a marked decrease in the number of primary care physicians.  These issues led to serious fractures in the health care system at the primary care level.  The NHSC has become a critical part of the plan to repair the nation’s health care delivery system.

The NHSC program has had a clear and demonstrated positive impact in every area of the country.   It has created new health services in areas where Americans had little or no access to primary health care.  The crucial importance of this federal program is highlighted by the millions of Americans who are reliant upon the NHSC for primary care.

National Advisory Council on the National Health Service Corps

From its inception, the fifteen-member National Advisory Council on NHSC (Council) was created by Congress to advise the administration on the NHSC.  The members are part of the health professional workforce, as well as specialists with knowledge of underserved communities and health care implementation and improvement.  Together, they create an invaluable field of knowledge for the Secretary of the U.S. Department of Health and Human Services (HHS), and the Administrator of the Health Resources and Services Administration (HRSA).

The Council has spent the last year engaged in extensive review of the NHSC program, including its legislation, policies and procedures.  As a result of this review, the Council finds the need for increased investment in the NHSC to respond to the growing access gaps in underserved areas to primary health care.  Currently, there are 50 million Americans who lack access to primary health care.  Meeting this immediate need requires 27,000 primary care professionals willing to serve in Health Professional Shortage Areas (HPSA).^[1]   This represents a more than five-fold increase over the current 4,600 clinicians who diligently serve in the NHSC programs. The Council believes doubling the NHSC in its capacity of recruiting, matching and retaining primary care clinicians for underserved areas will positively impact the current challenge before the nation. 

National Advisory Council Priorities

The Council believes that primary health care should be within the reach of every American, regardless of income or location.  The NHSC is the key to improved access to primary care for the underserved.

The number of Americans who are underserved and lack access to primary care is 50 million and still growing.  These individuals are often forced to utilize emergency rooms—or go without medical care entirely—because they do not have access to primary care.  This creates additional stress on an already overburdened health care system. The NHSC is a crucial part of the solution, placing clinicians where they can effectively address the most critical needs. 

The programs of the NHSC do exactly that, and they have proven results.  Each primary care physician brings health care access to 2,000 more patients on average ^[2].  Thus, increasing the NHSC’s field strength with 5,000 more clinicians will provide approximately 10,000,000 additional underserved Americans with needed primary care.  If these underserved Americans do not receive the primary care they need, they will face higher costs and lower quality in America’s currently overspecialized system. ^[3]  

Efforts to address this significant challenge are already underway, and increased support of the NHSC will only supplement these efforts.  The Presidential Initiative to Strengthen the Health Care Safety Net is already in the process of expanding or creating 1,200 new Community Health Centers (CHCs) in areas with the greatest need.  It will require 3,000 new clinicians for those new CHCs to achieve full staff.  The NHSC can serve as a crucial staffing resource for those CHCs, as well as other underserved areas.  Allowing the two programs to grow together creates economies of scale and dramatic cost savings by leveraging recruiting, placement, and service objectives of each program.

There is an urgent need for an estimated 27,000 additional clinicians to help close our nation’s gap in access to primary care.  With a five-year plan to more than double the NHSC’s field strength to 10,000, the Council sees an opportunity to begin making progress toward the goal of providing primary health care for every American.  This strategy will enable the NHSC to contribute to the President’s goal of strengthening the Health Care Safety Net. 

The Council recommends reauthorization of the NHSC for five years, and protection and enhancement of NHSC funding to at least double its capacity.  The Council also recommends legislative changes to increase program flexibility and efficiency.

Legislative Recommendations

1. Reauthorize NHSC for five years with increased appropriations sufficient to double its field strength to 10,000 primary care clinicians in underserved areas.
   
   
2. Allow cancellation of loan repayment contracts by the Secretary, with or without the clinician’s consent, if the clinician’s employment with the approved site ends within 90 days of the service start date, and no loan repayment funds were awarded.
   
   Within the language describing cancellation prior to the start of service, remove the time statement of 45 days before the end of the fiscal year (August 17).
   
   
3. Give the Secretary the option of reappointing any member of the Council for one additional three-year term.
   
   
4. Authorize an additional appropriation of 8% of the total loan repayment funding for states that administer a State Loan Repayment Program (SLRP).  This amount (a total of $500,000 for fiscal year 2008) will pay for grant-related administrative costs, including marketing. 
   
   
   This should not be subject to the matching funds requirement and should not allow for indirect cost reimbursement.
   
   
5. Allow states that administer an SLRP to determine the disposition of clinicians placed in default, as long as there is a mechanism established to recoup funds already disbursed.
   
   
6. Give authority for NHSC to conduct demonstration projects.  The budget for these expansions shall be determined by the Secretary as deemed appropriate and shall be limited to no more than 2% of the budget in any given year.

Conclusion

Protecting and enhancing NHSC funding will help support the President’s Health Care Safety Net across underserved communities.  The recommended legislative changes will also increase the flexibility and efficiency of the NHSC program, allowing it to better serve those who rely on its programs for primary health care, reduced costs, and improved health status.