This article is cross-posted from and in partnership with the National Latina Institute for Reproductive Health, and is published as part of a series on cervical cancer.
See all our coverage of Cervical Cancer Awareness Month 2012 here.
The uninsured, the underinsured and those living in underserved communities in which health care services are scarce are the segments of the U.S. population that are disproportionately affected by cervical cancer. These populations include women in rural areas, the elderly, those with less formal education, and women of color. For example, the mortality rate for African-American and Vietnamese women continues to be twice as high as for white women – and about 50 percent higher for Latinas. Meanwhile, in rural communities, uninsured white women have some of the poorest access to routine screening of any patient population. Thus, cervical cancer incidence rates vividly demonstrate inequities in our health care systems and outcomes.
Community health centers supported by the Health Resources and Services Administration (HRSA) address this disparity by providing preventive health services – including Pap tests and HPV vaccinations – to any woman, regardless of insurance status and/or ability to pay. As such, health centers play a vital role in redressing health disparities and delivering care to groups excluded in the health care system, such as immigrants.
For example, in 2010, more than 11 million patients served in community health centers were women and girls, or 6 out of every 10 patients. Of that population, 69% were women over 20 – comprising the largest single patient-category in the system. In addition to HPV vaccines, health centers administered Pap tests to about 1.8 million women, resulting in 120,167 abnormal cervical findings. Of the 9,592 attending physicians in health centers, almost 1 in 10 was an OB-GYN specialist, accounting for more than 3 million patient visits-or 9% of the 34 million visits to health centers annually.
The passage of the Affordable Care Act will allow community health centers to make an even greater impact on access to preventive health services. Under the Affordable Care Act, cervical cancer screenings are already covered with no cost sharing for new health plans. Furthermore, the Affordable Care Act created the Community Health Center fund which will provide $11 billion over a five-year period to assist in the expansion, improvement and creation of new health centers throughout the country. In September 2011, the Department of Health and Human Services (HHS) made $700 million in funds available to health centers: $600 million for current community health centers to expand operations and serve more patients and $100 million to help health centers address immediate needs. And in August 2011, HHS awarded nearly $30 million to create the New Access Points program, which will help health centers delivery primary and preventive care to an additional 286,000 patients.
Community health centers are poised to play a large role in increasing access to preventive and primary health care. Other provisions of the Affordable Care Act, including no-cost sharing for preventive services under private health insurance plans and non-discrimination protection for women with pre-existing conditions, also serve to bring down barriers to health care for women. Additionally, while greater research is needed, a recent study at the National Cancer Institute suggests that the HPV vaccine seemed to be about as effective whether women had 1, 2, or 3 doses; a development which may increase access to the HPV vaccine for women who seek it.
With the nation spending over $1.4 billion a year on cervical cancer treatment, these basic preventive services not only provide crucial access to care to the most vulnerable of populations, but also serve to reduce health care costs overall by emphasizing prevention and reducing the need for costly disease treatment and emergency room costs.