Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Emory Rollins School of Public Health, Atlanta, GA, USA.
Med Care Res Rev. 2020 Feb;77(1):3-18. doi: 10.1177/1077558719848283. Epub 2019 May 13.
Community health centers (CHCs) deliver affordable health services to underserved populations, especially uninsured and Medicaid enrollees. Since the early 2000s, CHCs have grown because of federal investments in CHC capacity and expansions of Medicaid eligibility. We review 24 relevant studies from 2000 to 2017 to evaluate the relationship between CHCs, policies that invest in services for low-income individuals, and access to care. Most included studies use quasi-experimental designs. Greater spending on CHCs improves access to care, especially for low-income and minority individuals. Medicaid expansions also increase CHC use. Some studies indicate that CHC investments complement Medicaid expansions to increase access cost-effectively. Further research should explore patient preferences and patterns of CHC utilization versus other sites of care and population subgroups for which expanding CHC capacity improves access to care most. Researchers should endeavor to use measures and sample definitions that facilitate comparisons with other estimates in the literature.
社区卫生中心（CHCs）为服务不足的人群，特别是未参保和享受医疗补助的人群，提供负担得起的医疗服务。自 21 世纪初以来，由于联邦对 CHC 能力的投资以及医疗补助资格的扩大，CHC 得到了发展。我们回顾了 2000 年至 2017 年的 24 项相关研究，以评估 CHC、为低收入个人提供服务的政策与获得医疗保健之间的关系。大多数纳入的研究使用了准实验设计。增加对 CHC 的投入可以改善医疗保健的可及性，特别是对低收入和少数族裔个人而言。医疗补助的扩大也增加了 CHC 的使用。一些研究表明，CHC 投资与医疗补助的扩大相辅相成，可以更有效地提高获得医疗保健的机会。进一步的研究应该探索患者的偏好和 CHC 利用与其他医疗场所和最需要扩大 CHC 能力以改善获得医疗保健机会的人群亚组的利用模式。研究人员应努力使用便于与文献中其他估计值进行比较的措施和样本定义。
