Health Care Manage Rev. 2022;47(2):E32-E40. doi: 10.1097/HMR.0000000000000327.
Federally qualified health centers (FQHCs) are pivotal safety net primary care providers for the medically underserved. FQHCs have complex organizational designs, with many FQHCs providing care at multiple physical locations ("sites"). The number of sites, however, varies considerably between FQHCs, which can have important implications for differential access that may perpetuate disparities in quality of care.
The objective of this study is to explore the organizational and environmental antecedents of the number of sites operated by each FQHC. The findings of this study contribute to a better understanding of FQHCs' expansion that has vital implications for cost and access outcomes.
METHODOLOGY/APPROACH: The study is based on data between the years 2012 and 2018. Using multivariate growth curve modeling, we analyzed the final sample, consisting of 5,482 FQHC-years.
The level of competition, measured as the number of FQHC sites in the Primary Care Service Area (PCSA) and the number of primary care physicians per 1,000 PCSA residents, was positively associated with the number of FQHC sites. The number of patients, the level of federal grant, and the year were also positively associated with the number of FQHC sites, whereas percentage of Medicaid patients; workforce supply, measured as primary care physician assistants per 1,000 PCSA residents; Medicaid expansion; and state/local funding available for FQHCs were not.
Findings of this study indicate that competition, especially between peer FQHCs, is significantly associated with FQHC expansion.
This result suggests that FQHC managers and policymakers may closely monitor cost, access, and quality implications of competition and FQHC expansion.
合格的联邦健康中心（FQHC）是医疗服务不足人群的重要基层医疗保障提供者。FQHC 具有复杂的组织设计，许多 FQHC 在多个物理地点（“站点”）提供服务。然而，各 FQHC 的站点数量差异很大，这可能对差异准入产生重要影响，从而使医疗质量的差异永久存在。
本研究旨在探讨每个 FQHC 运营的站点数量的组织和环境前因。本研究的结果有助于更好地了解 FQHC 的扩张，这对成本和准入结果具有重要意义。
方法/方法：本研究基于 2012 年至 2018 年的数据。使用多元增长曲线建模，我们分析了最终样本，由 5482 个 FQHC 年组成。
竞争水平，以初级保健服务区（PCSA）中的 FQHC 站点数量和每 1000 名 PCSA 居民的初级保健医生数量来衡量，与 FQHC 站点数量呈正相关。患者数量、联邦拨款水平和年份也与 FQHC 站点数量呈正相关，而 Medicaid 患者比例、劳动力供应，以每 1000 名 PCSA 居民的初级保健医生助理数量来衡量、 Medicaid 扩大以及州/地方为 FQHC 提供的资金则不然。
本研究的结果表明，竞争，特别是同行 FQHC 之间的竞争，与 FQHC 的扩张密切相关。
这一结果表明，FQHC 管理人员和政策制定者可能会密切监测竞争和 FQHC 扩张对成本、准入和质量的影响。
