AAFP to Congress: 'Section 747 Works'

The AAFP has called on Congress to take steps to improve the quality of U.S. health care, reduce health costs and ensure medical staffing for community health centers by budgeting $88.8 million for Section 747 of Title VII in the Public Health Service Act for fiscal year 2007. If enacted, that budget would boost Section 747 funding back to its FY 2005 level, up from the $41 million allocated for FY 2006.

The call came in a March 31 statement (PDF file: 5 pages / 523 KB. More about PDFs.) for the record submitted to the House Appropriations Subcommittee on Labor, Health and Human Services, and Education. In the statement, the Academy also urged Congress to fund the Agency for Healthcare Research and Quality, or AHRQ, at $440 million for FY 2007.

Section 747 of Title VII is the federal program that provides funds to academic departments and programs to increase the number of primary care professionals. AHRQ is the lead federal agency that funds research on comparative clinical effectiveness, health information technology and patient safety, according to the statement. That's in addition to the agency's long-standing role in translating basic research findings into information primary care physicians can use every day in their practices.

Citing a March 1 article in the Journal of the American Medical Association, the AAFP statement notes that community health centers, or CHCs, have an ongoing, serious shortage of primary care physicians to care for the medically underserved and uninsured. An unpublished 2006 study from the University of California, San Francisco, and the Robert Graham Center in Washington found that nearly 4,000 family and primary care physicians who had been exposed to programs supported by Title VII funding as medical students subsequently opted to work in a CHC.

Without Section 747 funding, CHCs likely would have "twice as many vacancies," the statement says. The Bush administration has expressed an interest in expanding CHC programs around the country.

Moreover, data demonstrate that increasing the number and proportion of primary care physicians improves health outcomes and lowers costs, the statement continues.

"Section 747 plays a role in lowering our nation's health care costs and increasing the quality of U.S. health care," the statement says. Citing an article in Health Affairs, the statement notes that spending more on Medicare actually lowered the quality of care.

Why? Data showed that "expensive health care did not improve patient satisfaction or outcomes" and "the makeup of the health care workforce made a difference: more primary care doctors in a state meant high quality care and lower cost. In contrast, more specialists and fewer generalists led to lower quality and higher costs," the statement notes.

A second Health Affairs study showed a negative relationship between the supply of primary care physicians and overall mortality. Specifically, adding one primary care physician per 10,000 people was associated with a decrease of 34.6 deaths per 100,000 people, the AAFP statement says.

The studies "make an irrefutable case for funding Section 747," the statement concludes. "Section 747 works."

In addition to calling for support of primary care education, the Academy urged Congress to budget $440 million for AHRQ. Without adequate support, AHRQ cannot continue translating research into pragmatic medical care, according to the statement.

"AHRQ has long supported research on conditions that affect most people," the statement says. "Most Americans get their medical care in doctors' offices and clinics. However, most medical research comes from the study of extremely ill people in hospitals. AHRQ studies and supports research on the types of illness that trouble most people. In brief, AHRQ looks at the problems that bring people to their doctors every day -- not the problems that send them to the hospital."