Federally qualified health centers (FQHCs)
Federally qualified health centers (FQHCs) are public and private non-profit health care organizations that receive federal funding under Section 330 of the Public Health Service Act. Governed by a community board, FQHCs deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay. FQHCs are located in high need communities in urban and rural areas1. Often called Community Health Centers (CHCs), FQHCs can also include migrant health centers, health care for the homeless centers, public housing primary care centers, and outpatient health programs or facilities operated by a tribe or tribal organization2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased access to health care
Improved health outcomes
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased continuity of care
Increased access to oral health care
What does the research say about effectiveness? This strategy is rated scientifically supported.
There is strong evidence that federally qualified health centers (FQHCs) increase access to primary care3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and improve health outcomes for their patients8, 9, 14, 15, 16, 17.
FQHCs have been shown to perform as well as or better than non-safety net providers on measures of quality and access to care, such as continuity of care and delivery of preventive services4, 9, 10, 17, 18 particularly for children7 and elderly patients16. FQHCs may improve access to oral health care19 and appear to provide effective care for PTSD14. FQHCs that become advanced primary care practices (APCPs) or that adopt principles of the patient centered medical home may further improve health and health care20, 21.
By serving uninsured, underinsured, and other vulnerable patients, FQHCs can reduce disparities in access to care4, 6, 9, 10, 22. For example, black and Hispanic patients at FQHCs appear to have fewer hospitalizations due to ambulatory care-sensitive conditions than peers who receive care elsewhere15.
Patients who receive most of their ambulatory care at community health centers such as FQHCs have lower overall medical expenditures than those who receive care elsewhere23. Many patients continue to use FQHCs even after obtaining insurance24.
Investments in community health centers have been shown to reduce costs for local health care systems and provide economic benefits for surrounding communities13, 25, 26, 27.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
In 2017, there were 1,373 federally qualified health centers (FQHCs) in the United States and its territories, with over 110 million patient encounters or visits. Delaware had the fewest centers, at three, while California had the most, at 17728; most Californians live within a 30 minute drive of an FQHC29.
As of 2016, 29 states provided direct funding to community health centers, totaling $335 million. From 2015 to 2016, 13 states planned to decrease or eliminate funding, six states planned to maintain current funding levels, and ten states planned to increase funding for safety net providers, including FQHCs30.
Implementation Resources
CiMH-Jarvis 2011 - Jarvis D, Freeman J. Toolkit of promising practices for financing integrated care in the California safety net. Sacramento: California institute for Mental Health (CiMH); 2011.
NCIOM - North Carolina Institute of Medicine (NCIOM). Health care services for the uninsured and other underserved populations: A technical assistance manual to help communities create or expand health care safety net services. Durham: North Carolina Institute of Medicine (NCIOM); 2008.
Footnotes
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1 HRSA-Health centers - Health Resources and Services Administration (HRSA). What is a health center?
2 CMS-FQHC - Centers for Medicare & Medicaid Services (CMS). Federally Qualified Health Center (FQHC). Baltimore, MD: US Department of Health and Human Services (US DHHS); 2016.
3 Urban-Saloner 2014 - Saloner B, Kenney GM, Polsky D, et al. The availability of new patient appointments for primary care at federally qualified health centers: Findings from an audit study. Washington, DC: The Urban Institute; 2014.
4 Shi 2013 - Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. Journal of Health Care for the Poor and Underserved. 2013;24(1):56-66.
5 Lo Sasso 2010 - Lo Sasso AT, Byck GR. Funding growth drives community health center services. Health Affairs. 2010;29(2):289-96.
6 Siegel 2004 - Siegel B, Regenstein M, Shin P. Health reform and the safety net: Big opportunities; major risks. Journal of Law, Medicine & Ethics. 2004;32(3):426-32.
7 Gresenz 2006 - Gresenz CR, Rogowski J, Escarce JJ. Dimensions of the local health care environment and use of care by uninsured children in rural and urban areas. Pediatrics. 2006;117(3):e509-17.
8 Bodenheimer 2010 - Bodenheimer T, Pham HH. Primary care: Current problems and proposed solutions. Health Affairs. 2010;29(5):799-805.
9 Hicks 2006 - Hicks LS, O’Malley AJ, Lieu TA, et al. The quality of chronic disease care in US community health centers. Health Affairs. 2006;25(6):1712-23.
10 O’Malley 2005 - O’Malley AS, Forrest CB, Politzer RM, Wulu JT, Shi L. Health center trends, 1994-2001: What do they portend for the federal growth initiative? Health Affairs. 2005;24(2):465-72.
11 Cunningham 2004 - Cunningham P, Hadley J. Expanding care versus expanding coverage: How to improve access to care. Health Affairs. 2004;23(4):234-44.
12 Shi 2007 - Shi L, Stevens GD, Politzer RM. Access to care for US health center patients and patients nationally: How do the most vulnerable populations fare? Medical Care. 2007;45(3):206-13.
13 Shi 2007a - Shi L, Stevens GD. The role of community health centers in delivering primary care to the underserved: Experiences of the uninsured and Medicaid insured. Journal of Ambulatory Care Management. 2007;30(2):159-70.
14 Meredith 2016 - Meredith LS, Eisenman DP, Han B, et al. Impact of collaborative care for underserved patients with PTSD in primary care: A randomized controlled trial. Journal of General Internal Medicine. 2016;31(5):509-517.
15 Wright 2015 - Wright B, Potter AJ, Trivedi A. Federally qualified health center use among dual eligibles: Rates of hospitalizations and emergency department visits. Health Affairs. 2015;34(7):1147-1155.
16 Ross 2012 - Ross JS, Bernheim SM, Lin Z, et al. Based on key measures, care quality for medicare enrollees at safety-net and non-safety-net hospitals was almost equal. Health Affairs. 2012;31(8):1739-48.
17 Goldman 2012 - Goldman LE, Chu PW, Tran H, Romano MJ, Stafford RS. Federally qualified health centers and private practice performance on ambulatory care measures. American Journal of Preventive Medicine. 2012;43(2):142-9.
18 Shi 2012 - Shi L, Lebrun LA, Zhu J, et al. Clinical quality performance in U.S. health centers. Health Services Research. 2012;47(6):2225-49.
19 Jones 2013 - Jones E, Shi L, Hayashi AS, et al. Access to oral health care: The role of federally qualified health centers in addressing disparities and expanding access. American Journal of Public Health. 2013;103(3):488-93.
20 RAND-Kahn 2015 - Kahn KL, Timbie JW, Friedberg MW, et al. Evaluation of CMS's federally qualified health center (FQHC) advanced primary care practice (APCP) demonstration: Final second annual report. Santa Monica: RAND Corporation; 2015.
21 Calman 2013 - Calman NS, Hauser D, Weiss L, et al. Becoming a patient-centered medical home: A 9-year transition for a network of federally qualified health centers. Annals of Family Medicine. 2013;11(Suppl 1):S68-S73.
22 Starfield 2005 - Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly 2005; 83(3):457-502.
23 Richard 2012 - Richard P, Ku L, Dor A, et al. Cost savings associated with the use of community health centers. Journal of Ambulatory Care Management. 2012;35(1):50-9.
24 Ku 2011 - Ku L, Jones E, Shin P, Rothenberg F, Long SK. Safety-net providers after health care reform: Lessons from Massachusetts. Archives of Internal Medicine. 2011;171(15):1379-84.
25 Rothkopf 2011 - Rothkopf J, Brookler K, Wadhwa S, Sajovetz M. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Affairs. 2011;30(7):1335-42.
26 Dor 2009 - Dor A, Richard P, Tan E, et al. Community health centers in Indiana: State investments and returns. New York: Geiger Gibson/RCHN Community Health Foundation Research Collaborative (RCHN CHF); 2009.
27 NACHC-Primary care 2007 - National Association of Community Health Centers (NACHC). Access granted: The primary care payoff. Washington, DC: National Association of Community Health Centers (NACHC), Robert Graham Center, Capital Link; 2007.
28 KFF-FQHC - The Henry J. Kaiser Family Foundation (KFF). Federally qualified health centers (FQHC).
29 Darsie 2015 - Darsie B, Rico J, Gadgil M, Tootoo J. Colorectal cancer burden and access to federally qualified health centers in California. Preventing Chronic Disease. 2015;12(E169):150162.
30 NACHC-State funding 2015 - Ertle L, McKinney D. State policy report #58: State fiscal year 2016 funding for community health centers: Results from NACHC’s 2015 annual PCA policy assessment. Washington, DC: National Association of Community Health Centers (NACHC); 2015.
Related What Works for Health Strategies
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