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Expanding CHS helps minority access to care
Policies to reduce uninsurance and expand community health center capacity should increase access to care for low-income people, as measured by having a usual source of care and an ambulatory care visit in the past year, according to a Center for Studying Health System Change (HSC) study published last year in Health Affairs.
Study lead author Jack Hadley, an HSC senior fellow and a principal research associate at the Urban Institute, tells State Health Watch that expanding community health center capacity has a positive effect on minority population access to care. "In principal," he says, "it should help close the access gap between whites and minorities."
Mr. Hadley says the greater expanded access to care for minorities may be related to population locations.
Bigger drops in coverage seen
In the study's simulation, expanded community health center funding resulted in small increases in access to care, with Spanish-speaking Hispanics registering the largest improvements in access. However, minorities also experienced bigger drops in insurance coverage and the net result was no improvements in the access measures for Spanish-speaking Hispanics and slight decreases in access for whites, English-speaking Hispanics, and African-Americans. Access gaps either remained the same or worsened slightly for English-speaking Hispanics and African-Americans relative to whites.
According to Hadley, racial and ethnic minorities consistently have higher rates of uninsurance than whites, by almost twofold for African-Americans and roughly threefold for Hispanics. And recent data have indicated the gap is increasing.
Since racial and ethnic minorities used community health centers more than do non-Hispanic whites, federal investments in those centers would be expected to narrow differences in access, although a growing gap in insurance coverage between whites and racial/ethnic minorities could frustrate that goal.
Mr. Hadley tells SHW that this study expands on earlier work using Community Tracking Study data. Simulations in the study were based on statistical models that treat both insurance coverage and safety net capacity as endogenous (internal) variables, but used an improved measure of safety net capacity: total community health center grant revenues per poor person within a five-mile radius of survey respondents.
The study is important, he says, because there are those who worry that expanding insurance coverage would be too costly and making greater use of community health centers would be a more controllable approach.
Measures can work
"This analysis suggests that policies to reduce uninsurance and expand community health center capacity will increase low-income people's access to care, as measured by having a usual source of care and an ambulatory care visit in the past year," Hadley says. "Moreover, minority groups' access appears to be more responsive to changes in insurance coverage and community health center capacity than non-Hispanic white's access. Thus, if policy changes were targeted equally to all low-income people, the gaps in access between whites and non-whites should be reduced. However, although eliminating uninsurance would have a sizable impact on minorities' access levels, it would not eliminate access gaps completely."
Analysis represents basic access
While the simulations suggest the Bush administration's community health center expansion might have offset much of the adverse effects on access of recent increases in uninsurance, Hadley emphasizes that the measures analyzed in the study represent only the most basic forms of access. "Although they are important indicators of access to primary and first-contact care, they might not capture variations in access to specific types of care, such as specialists, prescription drugs, expensive therapeutic procedures, or hospital care, or the total amount of care received," he says. "Investigating the relationships between insurance status and community health center capacity on these additional access measures is important for obtaining a complete picture of the extent to which community health centers fully substitute for insurance coverage."
A study abstract is available on-line at http://content.healthaffairs.org/cgi/content/abstract/25/6/1679. Contact Mr. Hadley at email@example.com or telephone (202) 261-5438.