The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Department of Internal Medicine, Division of Geriatric & Palliative Medicine, Ann Arbor, Michigan.
J Rural Health. 2019 Jun;35(3):385-394. doi: 10.1111/jrh.12330. Epub 2018 Oct 23.
Federally Qualified Health Centers (FQHCs), which were expanded under the Affordable Care Act, are federally funded health centers that aim to improve access to primary care in underserved areas. With continued federal support, the number of FQHCs in the United States has increased >80% within a decade. However, the expansion patterns and their impact on the population served are unknown.
A pre (2007)-post (2014) study of FQHC locations. FQHC locations were identified from the Provider of Services Files then linked to primary care service areas (PCSAs), which represent the service markets that FQHCs served. Road-based travel time was estimated from each 2007 FQHC to the nearest new FQHC as an indicator of geographic expansion in access. PCSA-level characteristics were used to compare 2007 and 2014 FQHC service markets.
Between 2007 and 2014, there was greater expansion in the number of FQHCs (3,489 vs 6,376; 82.7%) than in the number of service markets (1,835 vs 2,695; 46.9%). Nearly half of 2007 FQHCs (47%) had at least one new FQHC within 30 minutes travel time. Most newly certified FQHCs (81%) were located in urban areas. Compared to 2007 service markets, the new 2014 markets (N = 174) were much less likely to be in areas with >20% of the population below poverty (31.4% vs 14.9%, P < .001).
The latest expansion of FQHCs was less likely to be in rural or high poverty areas, suggesting the impact of expansion may have limitations in improving access to care among the most financially disadvantaged populations.
平价医疗法案（Affordable Care Act）下扩大的合格的联邦健康中心（Federally Qualified Health Centers，FQHCs）是一种由联邦政府资助的医疗中心，旨在改善服务不足地区的初级保健服务。在持续的联邦支持下，美国 FQHC 的数量在十年内增加了>80%。然而，其扩张模式及其对服务人群的影响尚不清楚。
一项 FQHC 地点的预（2007 年）后（2014 年）研究。从服务提供者档案中确定 FQHC 地点，然后将其与初级保健服务区（Primary Care Service Areas，PCSA）相链接，PCSA 代表 FQHC 服务的服务市场。从每个 2007 年的 FQHC 到最近的新 FQHC 的道路行驶时间被估计为获取地理扩张的指标。使用 PCSA 级别的特征来比较 2007 年和 2014 年的 FQHC 服务市场。
在 2007 年至 2014 年间，FQHC 数量的增长（3489 比 6376；82.7%）超过了服务市场数量的增长（1835 比 2695；46.9%）。近一半的 2007 年 FQHC（47%）在 30 分钟的车程内至少有一个新的 FQHC。大多数新认证的 FQHC（81%）位于城市地区。与 2007 年的服务市场相比，新的 2014 年市场（N=174）在人口贫困率>20%的地区的可能性要小得多（31.4%比 14.9%，P<0.001）。
最新的 FQHC 扩张不太可能在农村或高贫困地区进行，这表明扩张的影响可能在改善最弱势财务人群的医疗服务获取方面存在局限性。
