The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.

Catherine Myong,Vicki Fung,Peter Hull,Mary Price,Joseph P Newhouse,John Hsu,Jingjing Qian

doi:10.1371/journal.pone.0243279

Catherine Myong, Vicki Fung + Show 5 more

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https://doi.org/10.1371/journal.pone.0243279

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Abstract

ImportanceFederally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED).ObjectiveTo examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs.MethodsRetrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses.ResultsIn 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp).ConclusionsWe found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.

Highlights

We found that a standard deviation increase in prior year federally qualified health centers (FQHCs) funding (+31 percentage point) at the ZIP code level was associated with a 2.3pp increase in enrollees with FQHC visits and a 1.3pp
We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in emergency department visits (ED) visits for non-emergent conditions
Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions

Summary

Introduction

Increases in FQHC funding could improve access to primary care, especially for lowerincome populations without a usual source of care. Prior studies have shown that increases in FQHC federal funding are associated with growth in number of patients, visits, delivery sites, and scope of services at FQHCs, both before and after passage of the ACA [1,2,3]. Lowerincome adults and children residing in areas with more FQHCs or greater FQHC funding increases have been found to be more likely to have office visits [4, 5]

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