Expanding Federal Funding to Community Health Centers Slows Decline in Access for Low-Income Adults
Article first published online: 18 DEC 2013
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 3, pages 992–1010, June 2014
How to Cite
McMorrow, S. and Zuckerman, S. (2014), Expanding Federal Funding to Community Health Centers Slows Decline in Access for Low-Income Adults. Health Services Research, 49: 992–1010. doi: 10.1111/1475-6773.12141
- Issue published online: 16 MAY 2014
- Article first published online: 18 DEC 2013
- Assistant Secretary for Planning and Evaluation
- U.S. Department of Health and Human Services. Grant Number: HHS23320095654WC
- Health centers;
- access to care;
- primary care;
- safety net
To identify the impact of the Health Center Growth Initiative on access to care for low-income adults.
Data on federal funding for health centers are from the Bureau of Primary Health Care's Uniform Data System (2000–2007), and individual-level measures of access and use are derived from the National Health Interview Survey (2001–2008).
We estimate person-level models of access and use as a function of individual- and market-level characteristics. By using market-level fixed effects, we identify the effects of health center funding on access using changes within markets over time. We explore effects on low-income adults and further examine how those effects vary by insurance coverage.
We calculate health center funding per poor person in a health care market and attach this information to individual observations on the National Health Interview Survey. Health care markets are defined as hospital referral regions.
Low-income adults in markets with larger funding increases were more likely to have an office visit and to have a general doctor visit. These results were stronger for uninsured and publicly insured adults.
Expansions in federal health center funding had some mitigating effects on the access declines that were generally experienced by low-income adults over this time period.