Delivering ambulatory health care: the successful experience of an urban neighborhood health center.

During the past few years, the effectiveness of neighborhood health centers (NHCs) has been questioned, and curtailment of funding has indicated a lack of confidence in this organizational model. This article, however, reports on an urban NHC which has achieved considerable success in delivering health care to its target population at a moderate cost. Fifty-two per cent of all community residents and three-quarters of the children and adolescents were active users of the center. The majority of the patients were from low-income families and had established long-term relationships with center providers. Average visits per patient varied with age, sex, diagnosis and insurance coverage. Center physicians, trained as specialists, functioned primarily as general practitioners delivering preventive services, treating minor injuries and self-limiting diseases, and palliating chronic illness. Preventive care was planned as a focal point of the center's program, but third-party reimbursement policies and the lower priority that many patients placed on nonillness care were two major obstacles to the achievement of this goal. The average cost of health care other than mental health services was approximately $20 per visit and $74 per patient per year. Mental health treatment was more expensive. The findings suggest that reconsideration of the NHC as a viable model for delivering health care to the poor might be worthwhile.