Delivering health care to rural America : the community health center program in Southwest Virginia, 1975-1994

This dissertation is a history of Clinch River Health Services, Inc., a federally funded, rural community health center that has served the communities of Dungannon and Fort Blackmore in southwest Virginia since 1978. It is also a concise history of the evolution of the United States Public Health Service's rural health activities from 1900 through its administration of the community health center program, under the Rural Health Initiative policy. The dissertation concludes that the rural community health center program, in general, and Clinch River Health Services, in particular, have succeeded in delivering comprehensive, primary health care to medically-underserved communities. Consistent federal funding through the Public Health Service's Rural Initiative program (with its concept of positive program-ming) greatly contributed to the success. Also contributing to the success are components of the health care model itself: the inclusion of curative and preventive primary care; the use of health care teams, including mid-level providers; the commitment to community representation in governance; and the promotion of supplemental services, such as health education. However, the research demonstrates that the community health center program's success is vulnerable; at the national level, it depends on executive and legislative politics and bureaucratic management; at the local level, it depends on socioeconomic conditions; the ability to recruit and retain health care professionals, especially physicians; and the commitment and assertiveness of the board of directors. The research included a careful examination of Clinch River Health Services, Inc., applications for federal assistance; interviews with health care professionals, administrators, and board members at Clinch River Health Services, and Public Health Services officials; as well as a thorough reading of secondary sources. The dissertation consists of an introduction and seven chapters: 1. U.S. Public Health Service's Involvement in Rural Community Health Care, 1900 - 1960; 2. Legislative History of the Community Health Center Program, 1960 - 1977; 3. Introduction to Clinch River Health Services, Inc.; 4. Organization and Opening, 1975 - 1978; 5. Service and Crisis, 1979 - 1985; 6. Growth and Decline, 1986 - 1990; 7. Maturity and Success, 1991 - 1994.