Revisiting 'The clinic': ethical and policy challenges in U.S. community health centers

Health Econ Policy Law. 2014 Oct;9(4):425-34. doi: 10.1017/S1744133114000140. Epub 2014 May 20.


Where do poor people in the United States (US) go when they get sick? Often, they go to Federally Qualified Health Centers (FQHCs) and hospital emergency departments. Even after the implementation of the Patient Protection and Affordable Care Act (ACA), these safety-net health care organizations will continue to play a crucial role in the US health care system. FQHCs have long grappled with some of the biggest questions facing the US health care system and their leaders and clinicians face ethical challenges in everyday practice. Ethical and policy challenges in the US health care safety-net are not usually 'tragic choices' involving the allocation of transplantable organs, or ventilators during a pandemic. They are everyday choices with a tragic dimension because, even with the adoption of the ACA, the US has not yet decided whether poor people deserve a 'home' or a 'net' when they are sick, and whether even a net should be in good repair.

MeSH terms

  • Health Services Accessibility / ethics
  • Health Services Accessibility / organization & administration
  • Humans
  • Medicaid / economics
  • Medicine
  • Patient Protection and Affordable Care Act / legislation & jurisprudence
  • Policy*
  • Poverty*
  • Primary Health Care / economics
  • Primary Health Care / ethics
  • Primary Health Care / organization & administration*
  • Safety-net Providers / economics
  • Safety-net Providers / ethics
  • Safety-net Providers / organization & administration*
  • Uncompensated Care
  • United States