Community Care for All? Health Centers' Impact on Access to Care and Health

全民社区关怀？

基本信息

批准号：
8305292
负责人：
Martha Jane Bailey
金额：
$ 37.75万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-07-24 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8305292
关键词：
Adolescent Adult Affect Age Age Distribution Almond Nut American Caring Case Study Characteristics Child Chronic Disease Clinic Communities Community Health Centers Cost-Benefit Analysis County Crowding Data Data Collection Databases Disadvantaged Drug Formulations Early Diagnosis Economics Education Electronics Evaluation Funding Goals Growth Health Health Care Costs Health Insurance Health Policy Health Services Health Services Accessibility Healthcare Heterogeneity Hour Individual Infant Insurance Intensive Care Intervention Investments Knowledge Life Literature Long-Term Effects Longitudinal Studies Medical Methodology Neighborhoods Outcome Patients Policies Preventive Primary Care Physician Printing Program Description Public Health Race Recording of previous events Research Personnel Services Testing Time Travel Underserved Population Uninsured Wages Walking Work age group cost diabetes management economic outcome evidence base health care service utilization health disparity health economics improved meetings patient population policy implication programs safety net

项目摘要

DESCRIPTION (provided by investigator): Since 1965, Community Health Centers (CHCs) have delivered primary and preventive health care at free or reduced cost to disadvantaged and uninsured Americans. Although political support for CHCs has varied over time, both Republicans and Democrats have recently championed their expansion. Between 2001 and 2007, the Federal Health Center Growth Initiative doubled CHC funding from $1 to $2 billion (US DHHS 2008). More recently, the Patient Protection and Affordable Care Act (ACA) appropriates $11 billion to CHCs over five years in addition to $9.5 billion in annual discretionar funding with the goal of doubling the annual CHC patient population to 40 million by 2015. Many studies provide suggestive evidence that CHCs increase health care access, improve health, and reduce health disparities, but significant gaps in the literature-driven by the lack of data-limits knowledge about CHCs' effects. New, more precise estimates of the magnitude of and heterogeneity in CHCs' effects are key inputs for cost-benefit analyses and evidence-based public health policy formulation. This project aims to generate nationally-representative, shorter and longer-term estimates of CHCs' effects on health and economic outcomes and health care utilization by age group and race in order to fill these gaps. Specifically, we will (1) compile, synthesize, and digitize a comprehensive database on CHC funding and its potential determinants from 1965 to 2010, which we will release for public use; (2) describe the relationship between CHC funding and county-level characteristics from 1965 to 2010 and test the proposed studies' identifying assumptions; (3) quantify the shorter and longer-term impact of CHCs on health and economic (education, work hours, wages) outcomes by age and race; and (4) examine how CHCs achieved these effects by quantifying their impacts on health care utilization. The project makes a substantial and policy-relevant contribution to knowledge about CHCs' effects across places, time, demographic groups and service offerings and provides the first evidence of CHCs' longer-term and economic returns. Our combination of historical studies of CHCs' longer-term returns (effects that cannot be estimated in the recent period) with more contemporary evidence will significantly improve our understanding of CHCs and lay the groundwork-both in terms of data and methodology-for future research. PUBLIC HEALTH RELEVANCE: This project contributes to public health knowledge by seeking to understand the impact of U.S. Community Health Centers (CHCs) on access to health care and health outcomes from 1965 to the present. Our proposed studies will provide the most comprehensive set of evidence on the benefits of CHCs across the age distribution and by race. A better understanding of the impact of CHCs has direct policy implications for the expansion of this program under the Patient Protection and Affordable Health Care Act.

描述（由调查员提供）：自 1965 年以来，社区健康中心 (CHC) 一直向弱势群体和未参保的美国人免费或降低成本提供初级和预防性医疗保健。尽管随着时间的推移，对社区卫生中心的政治支持有所不同，但共和党和民主党最近都支持其扩张。 2001 年至 2007 年间，联邦健康中心增长计划将 CHC 资金增加了一倍，从 1 亿美元增加到 20 亿美元（美国 DHHS 2008）。最近，《患者保护和平价医疗法案》(ACA) 在五年内向 CHC 拨款 110 亿美元，此外还每年提供 95 亿美元的可自由支配资金，目标是到 2015 年将年度 CHC 患者人数增加一倍，达到 4000 万。许多研究提供了建议有证据表明社区卫生中心增加了医疗保健的可及性、改善了健康并减少了健康差距，但由于缺乏数据限制了有关 CHC 影响的知识。对社区卫生中心影响的程度和异质性进行新的、更精确的估计是成本效益分析和基于证据的公共卫生政策制定的关键投入。该项目旨在产生具有全国代表性的、更短的对社区卫生中心对健康和经济成果以及按年龄组和种族的医疗保健利用的影响进行长期估计，以填补这些空白。具体来说，我们将 (1) 编制、综合和数字化一个有关 1965 年至 2010 年 CHC 资金及其潜在决定因素的综合数据库，并将其发布供公众使用； (2) 描述 1965 年至 2010 年 CHC 资金与县级特征之间的关系，并检验拟议研究的识别假设； (3) 按年龄和种族量化 CHC 对健康和经济（教育、工作时间、工资）结果的短期和长期影响； (4) 通过量化 CHC 对医疗保健利用的影响来研究 CHC 如何实现这些效果。该项目对了解社区卫生中心在不同地点、时间、人口群体和服务提供方面的影响做出了重大且与政策相关的贡献，并提供了社区卫生中心长期和经济回报的第一个证据。我们将 CHC 长期回报（近期无法估计的影响）的历史研究与更多当代证据相结合，将显着提高我们对 CHC 的理解，并为未来的研究奠定数据和方法论的基础。公共卫生相关性：该项目旨在了解 1965 年至今美国社区健康中心 (CHC) 对获得医疗保健和健康结果的影响，从而为公共卫生知识做出贡献。我们提出的研究将为不同年龄分布和种族的 CHC 的益处提供最全面的证据。更好地了解 CHC 的影响对于根据《患者保护和平价医疗保健法案》扩大该计划具有直接的政策影响。