AHRQ, Center for Financing, Access and Cost Trends, 5600 Fishers Ln Rockville, MD 20852, United States.
Office of Quality Improvement Bureau of Primary Care Health Resources and Services Administration, 5600 Fishers Lane Rockville, MD 20852, United States.
Healthc (Amst). 2017 Dec;5(4):174-182. doi: 10.1016/j.hjdsi.2016.12.006. Epub 2017 Jan 5.
Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period.
We pooled six years of data from the Medical Expenditure Panel Survey (2008-2013) and linked it to geographic data on CHCs from Health Resources and Services Administration's Health Center Program Uniform Data System. We also link other community characteristics from the Area Health Resource File and the Dartmouth Institute's data files. The associations between CHC availability and our access measures are estimated with logistic regression models stratified by insurance status.
The availability of CHC services was positively associated with both measures of access among those with no insurance coverage. Additionally, it was positively associated with having a usual source of care among those with Medicaid and private insurance. These findings persist after controlling for key individual- and community-level characteristics.
Our findings suggest that an enhanced CHC program could be an important resource for supporting the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improving access to quality primary care for underserved Americans.
根据《公共卫生服务法案》第 330 条资助的社区卫生中心（CHC）是美国医疗保障安全网的重要组成部分。《患者保护与平价医疗法案》大幅扩大了该计划，但 CHC 的可及性在多大程度上改善了整体医疗服务的可及性尚不清楚。在本文中，我们研究了社区内 CHC 服务的可及性与两项门诊医疗服务可及性的关键衡量标准之间的关联 - 是否有常规医疗服务提供者以及在一年期间是否有任何门诊医疗服务。
我们汇总了来自医疗支出调查（2008-2013 年）六年的数据，并将其与卫生资源和服务管理局的卫生中心计划统一数据系统中的 CHC 地理数据进行了链接。我们还从区域卫生资源文件和达特茅斯研究所的数据文件中链接了其他社区特征。使用逻辑回归模型，根据保险状况对 CHC 可用性和我们的访问措施进行分层，以评估两者之间的关联。
在没有保险覆盖的人群中，CHC 服务的可及性与两种衡量医疗服务可及性的指标均呈正相关。此外，对于拥有医疗补助和私人保险的人群来说，它与有常规医疗服务提供者之间也呈正相关。这些发现在控制了关键的个体和社区层面特征后仍然存在。
我们的研究结果表明，一个强化的 CHC 计划可能是支持平价医疗法案扩大医疗补助覆盖范围的有效性的重要资源，最终可以改善美国弱势群体获得高质量初级医疗服务的机会。
