So vital are community health centers in meeting the health care needs of communities across the country that President Bush has pledged to put "a health center in every poor county in America." Indeed, the president's Health Center Initiative calls for doubling the size of the health center program with 1,200 new and expanded sites that will serve 16 million patients by next year.

Montana currently has 18 of these centers. In 2004, 66,192 people throughout the state called community health centers their medical home, and one is located in Helena. It's called the Cooperative Health Center (CHC), and it has been providing primary health care to Lewis and Clark County residents, regardless of their ability to pay, since 1994. Patients are charged on a sliding fee scale to ensure that income or lack of insurance are not barriers to care.

August 6-12 is the annual National Health Center Week, which is focused on highlighting the community-based model of health care that is opening the doors of health and giving millions of Americans in need the chance for healthy and productive lives. The health center approach is meant to lower the costs of disease through accessible and affordable primary care and prevention. The National Association of Community Health Centers estimates that health centers save American taxpayers $7 billion per year by keeping people healthy and out of hospitals and costly emergency rooms.

Nationwide, health centers fill critical gaps in health care by serving the working poor, the uninsured, the medically underserved, and many high-risk and vulnerable populations. Health centers are the family doctor to one of every eight uninsured persons, one of every six low-income Americans, and one of every 10 rural Americans who otherwise would lack access to health care.

Locally, the Cooperative Health Center's target population consists of people who live below 200 percent of poverty, close to 16,000 people in Lewis and Clark County. Almost 29 percent of the county's population lives below 200 percent of poverty, 21 percent lacks health insurance, and 7.3 percent is on Medicaid.

In 2004, the CHC served 4,768 individual patients, a 17.6 percent increase over 2003, and sees an average of 175 new patients every month. Over the past three years, the insurance demographics of the CHC's patients have changed dramatically. In 2001, 45 percent of visits were with uninsured patients; by 2005, that percentage had climbed to 70 percent.

With two physicians, one dentist, and two nurse practitioners, the Helena CHC provides a wide range of services to its patients, including physicals, pap smears, colposcopy, flexible sigmoidoscopy, diabetes education, general dental care, vasectomy, newborn and pediatric care, diabetic and chronic disease care, pharmaceutical services, and Healthcare for the Homeless at God's Love.

The CHC also provides referral for specialty care and hospital services. St. Peter's Hospital provides lab, X-ray, and emergency room services to CHC patients on a sliding fee scale, and so do many specialists. Because Helena is a fairly small community, local specialists understand that it is part of their community responsibility to provide care to patients who cannot pay the full cost of their care. They appreciate knowing that they can send patients back to the CHC for continued health care after the health problem has been resolved.

Key to health centers' accomplishments is patient involvement in service delivery. Health centers are local, non-profit, community-owned health care providers that have governing boards -- the majority of which must be patients according to federal grant requirements -- that serve as community representatives and make decisions on services provided.

Here are some examples of how the Helena Cooperative Health Center is directed by the very people it serves:

n In 2000, after having operated a dental clinic staffed by volunteer dentists for a number of years, the waiting list had grown to about 500 people, and patients were waiting many months to see one of the dentists. The governing board then decided to apply for a federal grant that would allow it to hire a full-time dentist. In 2001, the CHC received the grant and hired a full-time dentist who now has more than 3,000 visits per year.

n During 2005, the CHC began contracting with a local pharmacy to provide certain medications at low prices to CHC patients. In addition, the CHC continues to offer assistance to its patients in applying for pharmaceutical company medication assistance programs.

n In response to the mental health crisis in the Helena area, the CHC recently received funding to hire a full-time mental health counselor and a case manager to provide services to its patients.

For nearly 40 years, the national network of health centers has provided high-quality, affordable primary care and preventive services to many Americans who would otherwise go without medical care. To find out more, stop by the Cooperative Health Center at 1930 Ninth Ave or call 443-2584.

Julie Burk is development and public information specialist at the Lewis and Clark City-County Health Department.