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

描述(由调查人员提供)：自1965年以来，社区卫生中心(CHCs)向处于不利地位和未参保的美国人免费或降低成本提供初级和预防性卫生保健。尽管对CHC的政治支持随着时间的推移而有所不同，但共和党人和民主党人最近都支持扩大CHC。2001至2007年间，联邦卫生中心增长倡议将CHC资金从10亿美元增加到20亿美元(美国国土安全部，2008年)。最近，患者保护和平价医疗法案(ACA)除了每年95亿美元的可自由支配资金外，还在五年内向CHC拨款110亿美元，目标是到2015年将每年的CHC患者人数翻一番，达到4000万人。许多研究提供了有启发性的证据表明，社区卫生保健中心增加了卫生保健的可及性，改善了健康，并缩小了健康差距，但文献中存在显著差距--这是由于缺乏 数据-限制关于CHC影响的知识。对CHC影响的大小和异质性的新的、更准确的估计是成本效益分析和基于证据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、更短的 以及按年龄组和种族对卫生保健中心对健康和经济结果以及保健利用的影响的长期估计，以填补这些差距。具体地说，我们将(1)汇编、合成和数码化关于1965年至2010年CHC资金及其潜在决定因素的综合数据库，并将其发布供公众使用；(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)按年龄和种族量化CHC对健康和经济(教育、工作时间、工资)结果的短期和长期影响；以及(4)通过量化CHC对卫生保健利用的影响，研究CHC如何实现这些影响。该项目对了解社区卫生保健机构在不同地点、时间、人口群体和提供的服务方面的影响做出了重大的、与政策相关的贡献，并首次提供了卫生保健机构长期和经济回报的证据。我们对CHC的较长期回报(近期无法估计的影响)的历史研究与更现代的证据相结合，将显著提高我们对CHC的理解，并为未来的研究奠定数据和方法方面的基础。

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.