title: The availability of community health center services and access to medical care.
abstract: BACKGROUND
  Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period.
  
  
  METHODS
  We pooled six years of data from the Medical Expenditure Panel Survey (2008-2013) and linked it to geographic data on CHCs from Health Resources and Services Administration's Health Center Program Uniform Data System. We also link other community characteristics from the Area Health Resource File and the Dartmouth Institute's data files. The associations between CHC availability and our access measures are estimated with logistic regression models stratified by insurance status.
  
  
  RESULTS
  The availability of CHC services was positively associated with both measures of access among those with no insurance coverage. Additionally, it was positively associated with having a usual source of care among those with Medicaid and private insurance. These findings persist after controlling for key individual- and community-level characteristics.
  
  
  CONCLUSIONS
  Our findings suggest that an enhanced CHC program could be an important resource for supporting the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improving access to quality primary care for underserved Americans.
authors.affiliation: AHRQ, Center for Financing, Access and Cost Trends, 5600 Fishers Ln Rockville, MD 20852, United States. Electronic address: jkirby@ahrq.gov.
authors.forename: James B
authors.initials: JB
authors.lastname: Kirby
authors.affiliation: Office of Quality Improvement Bureau of Primary Care Health Resources and Services Administration, 5600 Fishers Lane Rockville, MD 20852, United States. Electronic address: rsharma@hrsa.gov.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
mesh_terms: D003151:Community Health Centers / Q000600:supply & distribution; D003153:Community Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000592:standards*; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D011795:Surveys and Questionnaires
keywords: Access; Community health centers; Medicaid; Uninsured