• Open Access

Do patients have a voice? The social stratification of health center governing boards

Authors

  • Brad Wright PhD

    Postdoctoral Fellow, Corresponding author
    1. Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA
    • Correspondence

      Brad Wright PhD

      Postdoctoral Fellow

      Center for Gerontology and Healthcare Research

      Brown University

      121 S Main St Box G-S121-6

      Providence

      RI 02912

      USA

      E-mail: bradwright@brown.edu

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Abstract

Context

To ensure community responsiveness, federally qualified health centres (FQHCs) in the United States are required to be governed by a patient majority. However, to the extent that these patient trustees resemble the typical low-income patients served by FQHCs, status generalization theory suggests that they will be passed over for leadership positions within the board in favour of more prestigious individuals.

Methods

Using 4 years of data on health centre governing boards obtained from the Health Resources and Services Administration via a Freedom of Information Act Request, the likelihood of holding executive committee office is modelled as a function of trustee characteristics using Chamberlain's conditional logistic regressions.

Results

The results indicate that representative patient trustees are significantly less likely than other trustees to hold a position on the executive committee or serve as board chair.

Conclusions

Given the power of the board leadership to set the agenda, the reduced likelihood of representative patient trustees serving in leadership positions may ultimately limit the representative voice given to patients, making FQHCs potentially less responsive to their communities. These findings also have important implications for other settings where engaging and empowering patients is sought.

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