The community health care center: current status and future directions.

This paper presents an assessment of The Robert Wood Johnson Foundation's Municipal Health Services Program, a demonstration in five major cities of neighborhood-based health care delivery for inner-city residents, started in 1978 and supported until 1984. The program was successful in achieving higher levels of clinic utilization, as well as in integrating preventive and therapeutic services; it was less successful in reducing the dependence of inner-city residents on hospital-based ambulatory services. Although the neighborhood centers provided care at substantially lower cost than that of other public facilities, they remained dependent on outside financial support. The viability of the community health care centers at the end of the grant period is discussed, in terms of the changes that have affected the health delivery system in the seven years since the program was started, and in terms of expected changes over the next few years that will affect their future usefulness and stability. A series of alternatives that might provide for the health care needs of the indigent are also discussed.