The Health Resources and Services Administration (HRSA), one of twelve agencies in the U.S. Department of Health and Human Services (HHS), was created in 1982 by combining programs of the former Health Resources Administration and the Health Services Administration. Since its creation, HRSA has administered programs that improve and support community-based primary health care for low-income people, the training of health professionals, and maternal and child health. Over the years, HHS has assigned important new responsibilities to HRSA, including Ryan White CARE Act programs to fight AIDS; rural health policy; and organ donation initiatives. HRSA's 2001 budget was $6.23 billion, the highest in its history. The 2001 budgets for the agency's four main administrative units are: HIV/AIDS Bureau, $1.81 billion; Bureau of Primary Health Care, $1.33 billion; Maternal and Child Health Bureau, $964 million; and Bureau of Health Professions, $353 million.
The Challenge of the Uninsured. HRSA's stated mission is to guarantee all Americans access to health care and to eliminate health disparities among U.S. populations. At the end of 2000, almost 43 million Americans had no insurance to pay for health care. Many local providers of health care services to the poor and uninsured rely on a patchwork of uncertain and insufficient subsidies to keep their doors open. HRSA helps these providers remain viable by furnishing financial support, technical expertise and information on "best practices" in providing care to the uninsured.
In 2000, HRSA invested more than $1 billion in health centers and clinics in more than 3,000U.S. communities—facilities that annually provide primary health care services to more than 9 million people. Services are free for those who cannot afford them, while others pay on a sliding scale. About two-thirds of people served by HRSA programs have incomes below 200 percent of the federal poverty level; an equally high percentage are people of color. HRSA's National Health Service Corps places more than 2,500 primary-care clinicians in areas across the nation where medical care is scarce.
HRSA has increased access to health insurance for young people by working to implement the 1997 State Children's Health Insurance Program (SCHIP). Through the end of fiscal year 2000, more than 3.3 million children had gained health insurance coverage under this program.
Critical to access is the need for qualified, culturally competent health care professionals. Several HRSA programs promote a technically skilled medical workforce, support greater cultural diversity in health professions to meet the needs of an increasingly diverse nation, encourage medical professionals to serve vulnerable populations, and seek to ensure that medical education responds to changing demands in the health care marketplace.
HIV/AIDS. After Medicaid, HRSA is the largest single source of federal funding for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) health care. Since 1990, when Congress passed the Ryan White CARE Act, the agency has invested more than $8 billion in essential primary care and support services and life-saving medications for low-income, underinsured, and uninsured people living with HIV/AIDS. CARE Act programs annually reach some 500,000 people—more than half of the U.S. residents estimated to be living with HIV.
Better Health for Mothers and Children. HRSA carries primary federal responsibility for improving the health of the nation's mothers and children. The agency's annual Maternal and Child Health Services block grants to states support efforts to develop and maintain service systems that assure access to comprehensive health care for women before, during, and after pregnancy and childbirth; reduce infant mortality; immunize children; limit adolescent pregnancies; and make preventive and primary care services available to children and adolescents. Other HRSA grant programs reduce infant mortality in targeted high-risk communities and fund state efforts to develop or improve emergency medical services for children.
Other HRSA Priorities. In FY 2001, HRSA will invest $97 million to improve health care services for the 61 million people who live in rural America. To bridge health care gaps in rural and urban areas, the agency promotes telehealth—the use of electronic information and telecommunications technologies—to diagnose and treat patients. HRSA funds information and support networks on organ donations and transplantations and oversees an initiative to increase donations. As of early 2001, 76,000 people were on waiting lists for organ donations; about 22,000 organ transplantations occur each year.
The agency administers the Ricky Ray Hemophilia Relief Fund Act, which provides payments to individuals with blood-clotting disorders who contracted HIV through treatment with contaminated blood products between 1982 and 1987. Since 1996, HRSA has allocated $200 million to improve the health of residents in the United States-Mexico border region, a program in which more than 500,000 residents annually receive bilingual, culturally competent health care services at fifty HRSA-funded border health clinics.
HRSA publications may be obtained from the HRSA Information Center on-line at http://www.ask.hrsa.gov or by calling 1–888-Ask HRSA.
(SEE ALSO: HIV/AIDS; Maternal and Child Health; Maternal and Child Health Block Grant; Primary Care; Uninsurance; United States Department of Health and Human Services [USDHHS])
— ELIZABETH M. DUKE
