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：
8680044
负责人：
Martha Jane Bailey
金额：
$ 34万
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/8680044
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 health knowledge improved meetings patient population policy implication programs public health relevance 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.

描述（由调查员提供）：自1965年以来，社区卫生中心（CHC）以免费或降低的成本提供了基本和预防性的医疗保健，以使处境不利和不保险的美国人提供。尽管对CHC的政治支持随着时间的流逝而有所不同，但共和党人和民主党人最近都支持他们的扩张。在2001年至2007年之间，联邦卫生中心增长计划将CHC资金从1美元翻了一番，达到20亿美元（US DHHS 2008）。最近，《患者保护和负担得起的护理法案》（ACA）在五年内将110亿美元用于CHC，除了95亿美元的年度可支配资金外，到2015年，每年的CHC患者人口将年度卫生率增加一倍至4000万。许多研究提供了建议的证据，可提高CHC的证据，以增加医疗保健的访问，改善健康状况，并减少健康状况，但在健康方面差异，并在文献中降低了重要的差距，文献差异很大。数据限制有关CHC效应的知识。 CHCS效应中的大小和异质性的新的，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。该项目旨在生成全国代表性的，较短的以及对CHC对健康和经济成果的影响以及按年龄组和种族划分的卫生保健利用的长期估计，以填补这些空白。具体而言，我们将（1）编译，合成和数字化有关CHC资金及其从1965年至2010年的潜在决定因素的综合数据库，我们将供公众使用；（2）描述1965年至2010年的CHC资金与县级特征之间的关系，并测试拟议的研究的识别假设；（3）按年龄和种族量化CHC对健康和经济（教育，工作时间，工资）结果的较短和长期影响；（4）检查CHC如何通过量化其对医疗保健利用的影响来实现这些影响。该项目对有关CHC在各个地方，时间，人口组和服务产品中的影响的知识方面做出了实质性且与政策相关的贡献，并提供了CHC的长期和经济回报的第一个证据。我们对CHC长期回报的历史研究（最近无法估算的）与更现代的证据的结合将显着改善我们对CHC的理解，并在数据和方法中为未来的研究提供基础工作。