title: Health Center Patients' Insurance Status and Healthcare Use Prior to Implementation of the Affordable Care Act.
abstract: BACKGROUND
  U.S. health centers provide primary and preventive care to underserved populations, including low-income and uninsured patients. The purpose of this study is to examine patterns of publicly funded health center use according to patient insurance status (private, public, none), prior to implementation of the Affordable Care Act.
  
  
  METHODS
  National data came from the 2009 Health Center Patient Survey, and were analyzed in 2013. Descriptive analysis of health center patient insurance coverage and health center utilization variables was conducted, followed by adjusted multivariate analysis.
  
  
  RESULTS
  About 91% of uninsured patients received at least half their annual healthcare visits at a health center, and 86% had at least one usual source of care that included a health center; these rates were not significantly different from those for publicly or privately insured patients. About half of uninsured patients (48%) had long tenures at the health center (≥3 years since first visit), not significantly different from the publicly insured (52%), but lower than the privately insured (63%, p<0.01). Uninsured patients highlighted affordability as the main reason for visiting a health center, whereas insured patients emphasized convenient location and quality of care.
  
  
  CONCLUSIONS
  Insured patients used health centers for the majority of their care, and in similar proportions to their uninsured counterparts. The primary motivation for visiting a health center differed based on insurance type. Future studies should be able to examine whether health center demand across insurance categories follows a similar pattern following the Affordable Care Act insurance coverage expansions.
authors.affiliation: Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, Rockville, Maryland. Electronic address: pmandsager@hrsa.gov.
authors.forename: Paul
authors.initials: P
authors.lastname: Mandsager
authors.affiliation: Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, Rockville, Maryland.
authors.forename: Lydie A
authors.initials: LA
authors.lastname: Lebrun-Harris
authors.affiliation: Office of Quality and Data, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland.
authors.forename: Alek
authors.initials: A
authors.lastname: Sripipatana
mesh_terms: D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult