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George Washington University, School of Public Health and Health Services, Department of Health Policy


Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 8


Community Health Centers; Health Reform; Health Homes


This research brief examines the experiences of Puerto Rico's community health centers under the Commonwealth’s 1994 Government Health Insurance Plan (GHIP) – the Commonwealth's Medicaid program – also known as the Reforma. Of particular interest are the effects of Medicaid under-financing coupled with health centers' continuing obligations to furnish subsidized care for uninsured patients. To finance GHIP, the Commonwealth substantially curtailed its involvement with the direct provision of health care in both community and inpatient settings, transforming the former system of direct care provision into health insurance premium subsidies.

In 2007, the 47 operating sites of Puerto Rico's 19 federally funded community health centers served nearly 10 percent of all Commonwealth residents. In many communities, health centers are the only source of affordable primary health care. As GHIP network providers, health centers furnished care to more than 200,000 beneficiaries in 2007, or 15 percent of all GHIP enrollees. Like their mainland counterparts, Puerto Rico's health centers are essential primary care providers for medically vulnerable populations.


Executive summary also available in Spanish.

Open Access


PRStudy_Spanish.pdf (128 kB)
Executive summary in Spanish