Wright Brad
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
J Prim Care Community Health. 2013 Jul 1;4(3):202-8. doi: 10.1177/2150131913475818. Epub 2013 Feb 6.
Federally qualified health centers (FQHCs), which must be governed by a patient majority, have historically struggled to remain financially viable while caring for a disproportionately low-income and uninsured population. Consumer governance is credited with making FQHCs responsive to community needs, but to the extent that patient trustees resemble the typical low-income FQHC patient, patient trustees might lack the capacity to govern, harming financial performance as a result. Thus, this study sought to empirically evaluate the relationship between FQHC board composition and financial performance.
Using data from years 2002-2007 of the Uniform Data System and the Area Resource File, and years 2003-2006 of FQHC grant applications, FQHC operating margin was modeled as a function of board and executive committee composition, the interaction between them, general time trends, other FQHC and county-level factors, and FQHC-level fixed effects. Trustees were classified as representative (ie, low-income) consumers, nonrepresentative (ie, high-income) consumers, and nonconsumers on the basis of their self-reported patient status and occupation.
Each 10 percentage point increase in the proportion of representative consumers on the board is associated with a 1.7 percentage point decrease in operating margin. This effect becomes insignificant if any consumers serve on the executive committee. There is no significant relationship between the proportion of nonrepresentative consumers and operating margin.
If consumers are given leadership roles on the board, consumer governance does not harm financial performance and may be beneficial enough in other respects to justify its being required as a condition of federal FQHC funding. Without such strengthening of the provision, consumer governance appears to harm financial performance and it is unclear from this study whether it offers other benefits that are significant enough to justify this financial risk.
联邦合格医疗中心（FQHCs）必须由多数患者进行管理，一直以来，它们在为低收入和未参保人口比例过高的人群提供医疗服务的同时，还面临着财务可持续性方面的难题。消费者治理被认为能使FQHCs响应社区需求，但如果患者受托人类似于典型的低收入FQHC患者，那么患者受托人可能缺乏治理能力，从而损害财务绩效。因此，本研究旨在实证评估FQHC董事会构成与财务绩效之间的关系。
利用统一数据系统2002 - 2007年以及区域资源文件的数据，还有FQHC拨款申请2003 - 2006年的数据，将FQHC营业利润率建模为董事会和执行委员会构成、它们之间的相互作用、一般时间趋势、其他FQHC及县级因素以及FQHC层面固定效应的函数。根据受托人自我报告的患者身份和职业，将其分为代表性（即低收入）消费者、非代表性（即高收入）消费者和非消费者。
董事会中代表性消费者比例每增加10个百分点，营业利润率就会下降1.7个百分点。如果执行委员会中有任何消费者任职，这种影响就会变得不显著。非代表性消费者比例与营业利润率之间没有显著关系。
如果赋予消费者在董事会中的领导角色，消费者治理不会损害财务绩效，而且在其他方面可能益处显著，足以证明将其作为联邦FQHC资金的一项要求是合理的。如果没有这种强化规定，消费者治理似乎会损害财务绩效，而且从本研究中尚不清楚它是否能提供其他足够显著的益处来证明这种财务风险是合理的。
