Association for Public Policy Analysis & Management

Community health centers provide primary care, as well as some dental and behavioral health services, to residents of medically underserved areas. In anticipation of the critical role health centers may play under the Affordable Care Act (ACS), the law included $11 billion in mandatory funding for health centers from 2011-2015. This funding was used in part to build new health center sites as well as to expand capacity at existing sites. This paper provides recent evidence on health centers’ impacts on access and use for low-income populations by analyzing the relationship between geographic proximity to a health center and measures of access to and utilization of health care services.

In this study, we describe how distance to a health center has changed for low-income adults during 2011-2015, a period of great change in terms of both the funding for health centers and insurance coverage, and assess how distance to a health center affects access, affordability, and health care utilization. Using geocoded data on the National Health Interview Survey (NHIS) merged with health center site-level data from the Health Resources and Services Administration’s Uniform Data System, we calculate the distance between NHIS survey respondents and the nearest community health center. We estimate the impact of proximity to a community health center on access to care measures including whether respondents identified a health center or clinic as their usual source of care; saw a general doctor in the past year; and had unmet need due to cost in the past year for medical care, dental care, mental health care or prescription drugs. We further stratify our results by age, urban/rural status, insurance status, and ACA Medicaid expansion and non-expansion states.

Preliminary results indicate that the average distance between nonelderly adults and the nearest health center was 7.2 miles in 2011 and fell to 5.7 miles in 2015. In rural areas, the average distance was 13.4 miles in 2011 and fell to 11.5 miles in 2015. During the same period, there was an increase in the share of adults whose nearest health center had any full-time behavioral health staff, from about 80% to 87%.

We also found that, among low-income adults in each year from 2011-2015, living closer to a health center was correlated with a higher probability of using a health center or clinic as a usual source of care, and a lower probability of reporting an unmet need for medical care due to cost. These early findings suggest that increased spending for health centers, as directed under the ACA, was successful in increasing proximity to community health centers. Our final results, expected in June 2017, will estimate the effects of the increased proximity to health centers over time on access to care for several vulnerable low-income populations.