Implementation of the health center concept in a rural community: a case study

A comprehensive health center integrates inpatient, outpatient, and public health services within the same medical and administrative structure. While health centers have been widely developed in other countries, only limited implementation has occurred in the United States. This case study documents the successful implementation of the health center concept in a sparsely populated area of northwestern New Mexico. This remote geographic setting and the socioeconomic characteristics of the area's tricultural population are described. The evolution of the delivery system with its network of satellite clinics predominantly staffed by mid-level primary care providers is presented. Program development and funding for the provision of a wide range of preventive and curative health services supported by communication, transportation, outreach, education, public health, and administration components are analyzed. Problems purported to hinder the implementation of comprehensive health centers in the United States are discussed from an experimental perspective.