A Profile of Community Health Center Patients: Implications for Policy
Community health centers play a central role in ensuring access to care in medically underserved communities across the country. Typically, they are located in low-income areas that are lacking in other health care resources. In 2011, over 1,100 federally funded health centers operating in about 8,500 urban and rural locations across the United States served more than 20 million patients. Health centers provide comprehensive primary medical care, often including behavioral health services and dental care, and provide support services such as translation, transportation, and case management that help patients to gain access to care. The nation’s reliance on health centers is likely to grow as health insurance coverage expands under the Affordable Care Act (ACA). Recognizing the need to expand the role of health centers, the ACA established a dedicated five-year $11 billion health center trust fund to broaden access to care in medically underserved, low-income communities.
Knowledge about the characteristics of health center patients and how they use care is important for several reasons. First, the increased emphasis on “patient-centeredness” that is part of comprehensive health system reform begins with an understanding of the patients being served. Second, such understanding is needed to inform policy specifically related to the establishment, operation, payment, and funding of community health centers. Third, it is likely that, as health centers grow in number and strength in response to the ACA’s insurance expansions and direct investments, the profile of health center patients may change. Health centers already play a key role in the provider networks of Medicaid and CHIP health plans, and, in many communities, they are expected to play a key role in the networks offered by Qualified Health Plans, especially plans offered by firms that do business in both the Medicaid market and the new Marketplaces (either through a single plan that satisfies the requirements of both markets, or through affiliated plans that share common networks). Establishing a profile of health center patients before the ACA is implemented sets the stage for measuring change over time, understanding the impact of the ACA, particularly the impact of state decisions regarding the Medicaid expansion, and assessing the environment in which health centers operate and the resources available to them to carry out their mission.
The Health Resources and Services Administration (HRSA)’s Bureau of Primary Health Care periodically collects information on a nationally representative sample of health center patients, through its Health Center Patient Survey. To learn more about the health center population, this brief compares data from the most recent Health Center Patient Survey, conducted in 2009, to data on the low-income* U.S. population, drawn from the National Health Interview Survey (NHIS), on which the Health Center Patient Survey is also modeled. The 2010 NHIS was used because it included more variables of interest for this study than the 2009 NHIS. Detail on the data and methodology associated with each of the two surveys are available in the Methods Appendix at the end of this report.
* In this paper, “low-income” is defined as income below 200% of the federal poverty level (FPL), which is $22,980 for an individual and $47,100 for a family of four in 2013.