“Geographic Variation in Access to Federally Qualified Health Centers and Health Outcomes”

Dissertation Committee

Evan S. Cole, PhD, Research Associate Professor, Department of Health Policy and Management (Committee Chair)

Brittany Brown-Podgorski, PhD, MPH, Assistant Professor, Department of Health Policy and Management

Coleman Drake, PhD, Associate Professor, Department of Health Policy and Management

Christina F. Mair, PhD, MPH, Professor, Department of Behavioral and Community Health Sciences

Abstract

Federally qualified health centers (FQHCs) provide essential primary care services to those living in Medically Underserved Areas and Populations at low or no cost. The Affordable Care Act expanded funding to FQHCs in 2010, increasing the number of centers annually. This dissertation explores the distribution of new FQHCs and how new centers impact access and health outcomes. 
 
Aim 1 examines associations between area-level characteristics and where new FQHCs are located. Urban census block groups with high area deprivation index (ADI) scores were more likely to have a new FQHC established within a 5-minute driving time and 30-minute public transit travel time from the block group centroid between 2010 and 2019. No association was found between ADI and new FQHCs within a 30-minute drive in rural areas. Aim 2 investigates whether new FQHCs improve health and access outcomes; having a usual source of care, having an office visit in the last year, and self-reported health and mental health. There were no differences in any outcomes after a new FQHC was established within a 5-minute driving time or 30-minute public transit travel time in urban areas. There was a small increase in self-reported fair or poor mental health among rural respondents after new FQHCs were established within a 30-minute drive time relative to those in areas without a new FQHC. Aim 3 investigates differences in changes in the same outcomes within two sets of subgroups; ADI of residence and individual race and ethnicity. After gaining an FQHC within a 5-minute drive in urban areas, rates of fair or poor self-rated health and mental health decreased for those in the most deprived areas relative to the least deprived. In the analyses by race and ethnicity, in rural block groups, rates of fair or poor mental health were lower among Black respondents relative to White respondents. 
 
FQHCs are being located in areas that likely have higher care needs, though health and access outcomes are not consistently improving after new FQHCs open. Targeted placement of FQHCs in combination with efforts to reduce other barriers to care will likely maximize the potential positive effects of FQHCs.