title: Access points for the underserved: primary care appointment availability at federally qualified health centers in 10 States.
abstract: BACKGROUND
  Federally Qualified Health Centers (FQHCs) are a vital source of primary care for underserved populations, such as Medicaid enrollees and the uninsured. Their role in delivering care may increase through new funding allocations in the Affordable Care Act and expanded Medicaid programs across many states.
  
  
  OBJECTIVE
  Examine differences in appointment availability and wait-times for new patient visits between FQHCs and other providers.
  
  
  METHODS
  We use experimental data from a simulated patient study to compare new patient appointment rates across FQHC and non-FQHC practices for 3 insurance types (private, Medicaid, and self-pay). Trained auditors, posing as patients requesting the first available new patient appointment, were randomized to call primary care providers in 10 states in late 2012 and early 2013. Multivariate regression models adjust for caller-level, clinic-level, and area-level variables.
  
  
  METHODS
  The sample comprises 10,904 calls, including 544 calls to FQHCs.
  
  
  RESULTS
  FQHCs grant new patient appointments at high rates, irrespective of patient insurance status. Adjusting for caller, clinic, and area variables, the Medicaid appointment rate at FQHCs is 22 percentage points higher than other primary care practices. Although the appointment rate difference between FQHCs and non-FQHCs is somewhat smaller for the self-pay group, FQHCs are much more likely to provide a lower-cost visit to these patients. Conditional on receiving an appointment, wait-times at FQHCs are comparable with other providers.
  
  
  CONCLUSIONS
  FQHCs' greater willingness to accept new underserved patients before 2014 underscores their potential key roles as health reform proceeds.
authors: *Leonard Davis Institute of Health Economics †Robert Wood Johnson Foundation Health and Society Scholar, University of Pennsylvania, Philadelphia, PA ‡Health Policy Center, Urban Institute, Washington DC §Center for Emergency Care Policy & Research ∥Perelman School of Medicine ¶Wharton School, University of Pennsylvania, Philadelphia PA.
authors: Michael R
authors: MR
authors: Richards
authors: Brendan
authors: B
authors: Saloner
authors: Genevieve M
authors: GM
authors: Kenney
authors: Karin
authors: K
authors: Rhodes
authors: Daniel
authors: D
authors: Polsky
mesh_terms: D001071:Appointments and Schedules; D003198:Computer Simulation; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011897:Random Allocation; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*