Community Care for All? Health Centers' Impact on Access to Care and Health

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DESCRIPTION (provided by investigator): Since 1965, Community Health Centers (CHCs) have delivered primary and preventive health care at free or reduced cost to disadvantaged and uninsured Americans. Although political support for CHCs has varied over time, both Republicans and Democrats have recently championed their expansion. Between 2001 and 2007, the Federal Health Center Growth Initiative doubled CHC funding from $1 to $2 billion (US DHHS 2008). More recently, the Patient Protection and Affordable Care Act (ACA) appropriates $11 billion to CHCs over five years in addition to $9.5 billion in annual discretionar funding with the goal of doubling the annual CHC patient population to 40 million by 2015. Many studies provide suggestive evidence that CHCs increase health care access, improve health, and reduce health disparities, but significant gaps in the literature-driven by the lack of data-limits knowledge about CHCs' effects. New, more precise estimates of the magnitude of and heterogeneity in CHCs' effects are key inputs for cost-benefit analyses and evidence-based public health policy formulation. This project aims to generate nationally-representative, shorter and longer-term estimates of CHCs' effects on health and economic outcomes and health care utilization by age group and race in order to fill these gaps. Specifically, we will (1) compile, synthesize, and digitize a comprehensive database on CHC funding and its potential determinants from 1965 to 2010, which we will release for public use; (2) describe the relationship between CHC funding and county-level characteristics from 1965 to 2010 and test the proposed studies' identifying assumptions; (3) quantify the shorter and longer-term impact of CHCs on health and economic (education, work hours, wages) outcomes by age and race; and (4) examine how CHCs achieved these effects by quantifying their impacts on health care utilization. The project makes a substantial and policy-relevant contribution to knowledge about CHCs' effects across places, time, demographic groups and service offerings and provides the first evidence of CHCs' longer-term and economic returns. Our combination of historical studies of CHCs' longer-term returns (effects that cannot be estimated in the recent period) with more contemporary evidence will significantly improve our understanding of CHCs and lay the groundwork-both in terms of data and methodology-for future research. PUBLIC HEALTH RELEVANCE: This project contributes to public health knowledge by seeking to understand the impact of U.S. Community Health Centers (CHCs) on access to health care and health outcomes from 1965 to the present. Our proposed studies will provide the most comprehensive set of evidence on the benefits of CHCs across the age distribution and by race. A better understanding of the impact of CHCs has direct policy implications for the expansion of this program under the Patient Protection and Affordable Health Care Act.