• 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 Sources

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).

Study Design

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.

Data Collection

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.

Principal Findings

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.