Anthony T. Lo Sasso, PhDGayle R. Byck, PhD

University of Illinois at Chicago

Thanks to NICHD for grant support

BackgroundFQHCs make up the “front line” of the health

care safety netIn 2006 nearly 6 million (40%) of FQHCs' 15

million patients were uninsured another 5.3 million (35%) were Medicaid

recipients ~25% of the nation’s 3.4 million low-income

uninsured children receive care at an FQHC

Policy ChangeThe Health Centers Initiative (2002)

increased federal funding for FQHCs from just over $1 billion in 2001 to nearly $2 billion in 2007Number of health centers increased from

roughly 750 centers in 2001 to the recently reached milestone of 1200 centers in December 2007

However, there has been little research examining how the additional funds have affected service provision at FQHCs

Our GoalBy carefully modeling the relationship

between Federal grant dollars (as well as other revenue sources) and several important clinic-level service measures, our research sheds light on what the return has been on the investment of expanded federal grant support for FQHCs

Outcomes we hypothesize will be affected by increased grant supportGeneral scope of service (number of sites of

operation, 24 hour coverage, emergency medical care, and urgent medical care)The scope of service measures allow us to gauge the

reach of the FQHC and at least implicitly its ability to provide services to populations in need

Behavioral health care services (mental health treatment and counseling, 24 hour crisis intervention and counseling, and substance abuse treatment and counseling)Behavioral health services have recently been

recognized as a critical need in communities as public and private psychiatric hospital closures have accelerated throughout the 1990s

Uncompensated care (UC) provision

Number of FQHCs Over Time

400

500

600

700

800

900

1000

1100

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Mean Federal, State/Local, & Private/Foundation Grants

Mean provision of on-site 24-hour coverage and urgent care

Mean number of sites per FQHC

Mean provision of on-site behavioral health services

Mean uncompensated care provision

We use panel data multivariate methods to control for other stuffThe model is specified as:

Outcomect = α + β1 Grantsct + β2 Xct + γc + δt + εct

Where c references the FQHC and t is timeThe coefficients of interest are β1 which reflect the

effect of grant dollars on the outcome variableWe control for other factors that might be related

to the outcomes of interest (age, race, insurance status, and income distribution of clinic patients), plus FQHC fixed effects and time fixed effects

Summary Multivariate ResultsFederal Grants

($M)State/Local

Grants ($M)Private Grants

($M)Number of Sites 1.5011*** 0.2947*** 0.8429***24 hour coverage 0.0116*** 0.0014 0.0193**Mental health treatment/counseling

0.0321*** -0.0001 0.0014

24 hour crisis intervention 0.0138** 0.0094** 0.0154

Substance use treatment/counseling

0.0356*** 0.0026 -0.0128

Uncompensated Care ($millions) 0.2669*** 0.1506*** 0.2243**

Discussion and Policy ExercisesOur results suggest that the recent investments

made in FQHCs impacted service provision along a number of important margins

To put the UC result in perspective, a hypothetical $500,000 increase in federal grant funding for the average clinic (which roughly corresponds to the average increase in federal grant funding observed between 1996 and 2001) is predicted to increase UC by $135,000 per clinicMean UC per uninsured patient was roughly $250, thus

the additional $135,000 in UC translates into 540 more uninsured patients treated, on average, per FQHC, or about a 10% increase in treatment of uninsured patients

Discussion and Policy ExercisesScaling the estimates up to the entire FQHC

program, a hypothetical $500,000 increase in grant support for each FQHCs would cost roughly $.5 billion, but treat an additional 500,000 uninsured patients in addition to allowing FQHCs to offer additional services important to communities

We also find suggestive results that FQHCs are able to leverage their federal grant support in order to gain additional state, local, and private grant dollars, which lead to still higher levels of service and UC provision

ConclusionThe recent Health Centers Initiative would

appear to have been a wise investment, though the ultimate proof is in the extent to which population health is improved, which is beyond the scope of this study

As a final note of caution, this type of research is getting more difficult to do because previously public information (e.g., uncompensated care, workforce staffing levels) is being deemed “confidential” and is no longer being made available to researchers