Health Care Management Science

, Volume 17, Issue 4, pp 348–364 | Cite as

Balancing investments in federally qualified health centers and Medicaid for improved access and coverage in Pennsylvania

  • Paul M. Griffin
  • Hyunji Lee
  • Christina Scherrer
  • Julie L. Swann
Article

Abstract

Two common health disparities in the US include a lack of access to care and a lack of insurance coverage. To help address these disparities, healthcare reform will provide $11B to expand Federally Qualified Health Centers (FQHCs) over the next 5 years. In 2014, Medicaid rules will be modified so that more people will become eligible. There are, however, important tradeoffs in the investment in these two programs. We find a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion) for the state of Pennsylvania. The comparison is achieved by integrating multi-objective mathematical models with several public data sets that allow for specific estimations of healthcare need. Demand is estimated based on current access and coverage status in order to target groups to be considered preferentially. Results show that for Pennsylvania, FQHCs are more cost effective than Medicaid if we invest all of the resources in just one policy. However, we find a better investment point balancing those two policies. This point is approximately where the additional expenses incurred from relaxing Medicaid eligibility equals the investment in FQHC expansion.

Keywords

Medicaid Federally qualified health centers Multi-criteria optimization Utility 

Supplementary material

10729_2013_9265_MOESM1_ESM.pdf (929 kb)
ESM 1(PDF 929 kb)

References

  1. 1.
    Blumenthal D, Mort E, Edward J (1995) The efficacy of primary care for vulnerable population groups. Health Services Research 30(1):253–273Google Scholar
  2. 2.
    Shi L (1992) The relationship between primary care and life chances. Journal of Health Care for the Poor and Underserved 3(2):321–335CrossRefGoogle Scholar
  3. 3.
    Shi L, Starfield B (2001) The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas. American Journal of Public Health 91(8):1246–1250CrossRefGoogle Scholar
  4. 4.
    Freeman HE, Kiecolt KJ, Allen HM (1982) Community health centers: an initiative of enduring utility. The Milbank Memorial Fund Quarterly. Health and Society 60(2):245–267Google Scholar
  5. 5.
    Okada LM, Wan TTH (1980) Impact of community health centers and Medicaid on the use of health services [findings of surveys conducted in ten urban and two rural areas; United States]. Public Health Reports 95:520–534Google Scholar
  6. 6.
    Fihn S, Wicher J (1988) Withdrawing routine outpatient medical services. Journal of General Internal Medicine 3(4):356–362CrossRefGoogle Scholar
  7. 7.
    Lurie N, Ward NB, Shapiro MF, Brook RH (1984) Termination from Medi-Cal - does it affect health? N Engl J Med 311(7):480–484CrossRefGoogle Scholar
  8. 8.
    Deprez R, Pennel B, Libby M (1987) The substitutability of outpatient primary care in rural community health centers for inpatient hospital care. Health Services Research 22(2):207–233Google Scholar
  9. 9.
    O’Connor P, Wagner E, Strogatz D (1990) Hypertension control in a rural community: an assessment of community-oriented primary care. Journal of Family Practice 30(4):420–424Google Scholar
  10. 10.
    Kaiser Family Foundation (2012) State health facts [Internet]. Available from: http://www.statehealthfacts.org/
  11. 11.
    U.S. Department of Health and Human Services (2012) Healthy people 2020 [Internet]. Available from: http://www.healthypeople.gov/2020/
  12. 12.
    Clemens-Cope L, Kenney GM, Buettgens M, Carroll C, Blavin F (2012) The affordable care act’s coverage expansions will reduce differences in uninsurance rates by race and ethnicity. Health Affairs 31:920–930CrossRefGoogle Scholar
  13. 13.
    Dievler A, Giovannini T (1999) Community health centers: promise and performance. Medical Care Research and Review 55(4):405–431CrossRefGoogle Scholar
  14. 14.
    Sommers BD, Tomasi MR, Swartz K, Epstein AM (2012) Reasons for the wide variation in Medicaid participation rates among states hold lessons for coverage expansion in 2014. Health Affairs 31:909–919CrossRefGoogle Scholar
  15. 15.
    Blavin F, Buettgens M, Roth J (2012) State progress toward health reform implementation: slower moving states have much to gain. Washington, DC: The Urban Institute. Available from: http://www.urban.org/UploadedPDF/412485-state-progress-report.pdf
  16. 16.
    Kenney GM, Huntress M, Buettgens M, Lynch V, Resnick D (2013) State and local coverage changes under full implementation of the Affordable Care Act. Washington DC: Kaiser Family Foundation. Available from: http://kff.org/health-reform/report/state-and-local-coverage-changes-under-full-implementation-of-the-affordable-care-act/
  17. 17.
    Health Resources and Services Administration (2013) Health center data: 2010 Pennsylvania data. [Internet]. Available from: http://bphc.hrsa.gov/uds/view.aspx?year=2010&state=PA
  18. 18.
    Stuart ME, Steinwachs DM (1993) Patient-mix differences among ambulatory providers and their effects on utilization and payments for Maryland Medicaid users. Medical Care 31(12):1119–1137CrossRefGoogle Scholar
  19. 19.
    Shi L, Stevens GD (2007) The role of community health centers in delivering primary care to the underserved: experiences of the uninsured and Medicaid insured. The Journal of Ambulatory Care Management 30(2):159–170CrossRefGoogle Scholar
  20. 20.
    Dor A, Pylypchuck Y, Shin P, Rosenbaum S (2008) Uninsured and Medicaid patients’ access to preventive care: comparison of health centers and other primary care providers. RCHN community health foundation research collaborative. Research Brief #4.Google Scholar
  21. 21.
    Carlson BL, Eden J, O’Connor D, Jerrilynn R (2001) Primary care of patients without insurance by community health centers. Journal of Ambulatory Care Management 24(2):47–53CrossRefGoogle Scholar
  22. 22.
    Adashi EY, Geiger HJ, Fine MD (2010) Health care reform and primary care—the growing importance of the community health center. N Engl J Med 362(22):2047–2050CrossRefGoogle Scholar
  23. 23.
    Griffin PM, Scherrer CR, Swann JL (2008) Optimization of community health center locations and service offerings with statistical need estimation. IIE Transactions 40(9):880–892CrossRefGoogle Scholar
  24. 24.
    Cunningham P, Hadley J (2004) Expanding care versus expanding coverage: how to improve access to care. Health Affairs 23(4):234–235CrossRefGoogle Scholar
  25. 25.
    Health Resources and Services Administration (2013) Find shortage areas: HPSA by State & Country [Internet]. Available from: http://hpsafind.hrsa.gov/
  26. 26.
    Brown TM, Parmar G, Durant RW, Halanych JH, Hovater M, Muntner P, Prineas RJ, Roth DL, Samdarshi TE, Safford MM (2011) Health professional shortage areas, insurance status, and cardiovascular disease prevention in the Reasons for Geographic and racial Differences in Stroke (REGARDS) study. Journal of Health Care for the Poor and Underserved 22(4):1179–1189CrossRefGoogle Scholar
  27. 27.
    Kohrs FP, Mainous AG (1995) The relationship of health professional shortage areas to health status. Implications for health manpower policy. Archives of Family Medicine 4(8):681–685CrossRefGoogle Scholar
  28. 28.
    Liu JJ (2007) Health professional shortage and health status and health care access. Journal of Health Care for the Poor and Underserved 18(3):590–598CrossRefGoogle Scholar
  29. 29.
    Kohrs FP, Mainous AG (1996) Is health status related to residence in medically underserved areas? Evidence and implications for policy. Journal of Rural Health 12(3):218–224CrossRefGoogle Scholar
  30. 30.
    Centers for Disease Control and Prevention (2013) National health and nutrition examination survey [Internet]. Available from: http://www.cdc.gov/nchs/nhanes.htm
  31. 31.
    U.S. Census Bureau (2013) PUMS (Public Use Microdata Sample) [Internet]. Available from: http://www.census.gov/
  32. 32.
    Phillips RL, Proser M, Green LA, Fryer GE, McCann J, Dodoo MS (2004) The importance of having health insurance and a usual source of care. American Family Physician 70(6):1035Google Scholar
  33. 33.
    National Association of Community Health Centers (2012) Federal regulatory policy report: Final Medicaid and Exchange Regulations. [Internet]. Available from: http://www.nachc.com/client/documents/4.12%20IB%20-%20MCD%20and%20Exchange%20Final%20Rules%20-%20FINAL.pdf
  34. 34.
    Department of Health and Human Services (2012) Medicaid program; eligibility changes under the Affordable Care Act of 2010. Fed Regist 77(57 Part III):17144–17217Google Scholar
  35. 35.
    Agency for Healthcare Research and Quality (2012) Medical expenditure panel survey [Internet]. 2012. Available from: http://meps.ahrq.gov/mepsweb/

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Paul M. Griffin
    • 1
  • Hyunji Lee
    • 1
  • Christina Scherrer
    • 2
  • Julie L. Swann
    • 3
  1. 1.Department of Industrial and Manufacturing EngineeringPenn State UniversityUniversity ParkUSA
  2. 2.Department of Industrial Engineering TechnologySouthern Polytechnic State UniversityMariettaUSA
  3. 3.School of Industrial and Systems EngineeringGeorgia Institute of TechnologyAtlantaUSA

Personalised recommendations