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

描述（由研究者提供）：自1965年以来，社区卫生中心（CHCs）为弱势和未投保的美国人提供免费或降低成本的初级和预防性卫生保健。虽然对社区卫生服务的政治支持随着时间的推移而变化，但共和党人和民主党人最近都支持扩大社区卫生服务。2001年至2007年，联邦卫生中心增长倡议将社区卫生中心的资金从10亿美元增加到20亿美元（美国卫生和公众服务部，2008年）。最近，《患者保护和平价医疗法案》（ACA）在五年内向CHC拨款110亿美元，此外每年还拨款95亿美元，目标是到2015年将每年CHC患者人数增加一倍，达到4000万人。 许多研究提供了暗示性证据，表明社区卫生中心增加了医疗保健的可及性，改善了健康状况，减少了健康差距，但由于缺乏 数据限制了对社区卫生服务影响的了解。对社区卫生服务影响的大小和异质性进行新的、更精确的估计是成本效益分析和以证据为基础的公共卫生政策制定的关键投入。 该项目旨在产生具有全国代表性的、较短的 以及按年龄组和种族对社区卫生中心对健康和经济结果以及卫生保健利用的影响的长期估计，以填补这些空白。具体而言，我们将（1）汇编、综合和分析一个关于1965年至2010年CHC资金及其潜在决定因素的综合数据库，并将其公布供公众使用;（2）描述1965年至2010年CHC资金与县级特征之间的关系，并测试拟议研究的识别假设;（3）量化社区卫生服务对不同年龄和种族的健康和经济（教育、工作时间、工资）结果的短期和长期影响;（4）通过量化社区卫生服务对医疗服务利用的影响，研究社区卫生服务如何实现这些影响。 该项目为了解社区卫生中心在不同地点、时间、人口群体和服务提供方面的影响做出了实质性和与政策相关的贡献，并首次证明了社区卫生中心的长期和经济回报。我们结合历史研究的CHCs的长期回报（影响，不能估计在最近一段时间）与更多的当代证据将显着提高我们的理解CHCs和奠定基础，无论是在数据和方法，为未来的研究。

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.