Access to oral health care: the role of federally qualified health centers in addressing disparities and expanding access.

OBJECTIVES: We examined utilization, unmet need, and satisfaction with oral health services among Federally Qualified Health Center patients. We examined correlates of unmet need to guide efforts to increase access to oral health services among underserved populations. METHODS: Using the 2009 Health Center Patient Survey, we performed multivariate logistic regressions to examine factors associated with access to dental care at health centers, unmet need, and patient experience. RESULTS: We found no racial or ethnic disparities in access to timely oral health care among health center patients; however, uninsured patients and those whose insurance does not provide dental coverage experienced restricted access and greater unmet need. Slightly more than half of health center patients had a dental visit in the past year, but 1 in 7 reported that their most recent visit was at least 5 years ago. Among health center patients who accessed dental care at their health center, satisfaction was high. CONCLUSIONS: These results underscore the critical role that health centers play in national efforts to improve oral health status and eliminate disparities in access to timely and appropriate dental services.

Access to medical care, dental care, and prescription drugs: the roles of race/ethnicity, health insurance, and income.

BACKGROUND: After accounting for socioeconomic factors and other demographic characteristics, racial/ethnic disparities in access to care were examined. METHODS: Using nationally representative data on 34,403 individuals from the 2004 Medical Expenditure Panel Survey (MEPS), multiple logistic regression analyses for five outcome measures were conducted: self-reports of being unable to get medical care, dental care, or prescriptions in the past year; and having no doctor or dentist visits in the past year. The main independent variables were race/ethnicity, income, and insurance status. RESULTS: Blacks and Hispanics were less likely to report difficulties in accessing medical care, dental care, and prescriptions as compared to whites. These disparities occurred primarily among the uninsured and Medicaid insured. More objective measures of utilization (ie, no doctor visit or dental visit during the past year) showed that minorities experienced less access than whites. CONCLUSIONS: Racial/ethnic disparities in access to care persist, and cannot be entirely explained by socioeconomic differences. In addition, the nature of these disparities depends on the socioeconomic position of racial/ethnic groups as well as the access measure used.

Access to and Disparities in Care among Migrant and Seasonal Farm Workers (MSFWs) at U.S. Health Centers.

OBJECTIVES: This study describes the characteristics of migrant and seasonal farm workers (MSFWs) served by federally-funded health centers and examines disparities in access to primary and preventive care between migrant health center (MHC) and community health center (CHC) program patients. METHODS: Cross-sectional analysis of the 2009 Health Center Patient Survey which has 2212 and 831 patients from CHC and MHC program patients, respectively. RESULTS: Our study showed that the MHC program provided comparable health care access and quality for MSFWs relative to CHC patients. However, there were challenges with access to primary care, such as getting timely medical and dental care and prescription medicine. DISCUSSION: These results affirmed the role of health centers in providing high-quality primary care and reducing disparities. However, continual efforts are needed to enhance access to and quality of care for MSFWs.

Vulnerability and unmet health care needs. The influence of multiple risk factors.

CONTEXT: Previous studies have demonstrated a strong association between minority race, low socioeconomic status (SES), and lack of potential access to care (e.g., no insurance coverage and no regular source of care) and poor receipt of health care services. Most studies have examined the independent effects of these risk factors for poor access, but more practical models are needed to account for the clustering of multiple risks. OBJECTIVE: To present a profile of risk factors for poor access based on income, insurance coverage, and having a regular source of care, and examine the association of the profiles with unmet health care needs due to cost. Relationships are examined by race/ethnicity. DESIGN: Analysis of 32,374 adults from the 2000 National Health Interview Survey. MAIN OUTCOME MEASURES: Reported unmet needs due to cost: missing/delaying needed medical care, and delaying obtaining prescriptions, mental health care, or dental care. RESULTS: Controlling for personal demographic and community factors, individuals who were low income, uninsured, and had no regular source of care were more likely to miss or delay needed health care services due to cost. After controlling for these risk factors, whites were more likely than other racial/ethnic groups to report unmet needs. When presented as a risk profile, a clear gradient existed in the likelihood of having an unmet need according to the number of risk factors, regardless of racial/ethnic group. CONCLUSION: Unmet health care needs due to cost increased with higher risk profiles for each racial and ethnic group. Without attention to these co-occurring risk factors for poor access, it is unlikely that substantial reductions in disparities will be made in assuring access to needed health care services among vulnerable populations.

Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status.

OBJECTIVES: The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. METHODS: Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. RESULTS: Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. CONCLUSIONS: Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

Nativity status and access to care in Canada and the U.S.: factoring in the roles of race/ethnicity and socioeconomic status.

We conducted cross-country comparisons of Canada and the U.S., and assessed the extent to which access to care varies by nativity status overall, as well as in conjunction with race/ethnicity and socioeconomic status. Data came from the Joint Canada-U.S. Survey of Health (n=6,620 non-elderly adults). Access measures included having a regular medical doctor, consultation with a health professional in the past year, dentist visit in the past year, Pap test in the past three years, and any unmet health care needs in the past year. Logistic regression was employed to estimate the relative odds of access to care, adjusting for potential confounders. Disparities in access to care based on nativity status overall, as well as nativity-by-race joint effects, were found in both countries. There was also a dose-response effect of education on access to care among the native-born but not among the foreign-born; there were few nativity-by-income joint effects.

Level of evidence of the value of care in federally qualified health centers for policy making.

THE PROBLEM: Community health centers (CHCs) are part of the United States' medical care safety net. Cost effectiveness is a critical element of value in today's health policy environment. Not all cost-effectiveness studies employ formal peer-reviewed methodologies. A review of the literature on CHCs' cost effectiveness is necessary to assess whether a higher level of evidence is needed to guide future policy. PURPOSE: We sought to review the quality of the evidence on the economic value of CHCs and indicate whether a higher of level evidence would be useful for making policy. KEY POINTS: Evidence exists to support the general value of care in CHCs, but no evidence comes from formal economic evaluations of CHC care. CONCLUSION: More formal cost-effectiveness evaluations would enhance the economic argument for CHCs but will remain difficult to conduct and may be unnecessary in light of other work on the value of care in CHCs.

Vulnerability and the receipt of recommended preventive services: the influence of multiple risk factors.

CONTEXT: Previous studies have confirmed the independent associations of race/ethnicity, socioeconomic status, and potential access with the receipt of preventive care. More pragmatic models of vulnerability are needed to examine the concomitant influence of multiple risk factors. OBJECTIVE: To operationalize vulnerability as risk profiles of predisposing (race/ethnicity and education) and enabling (eg, income, health insurance, and having a regular source of care) factors, and their association with the receipt of preventive care. STUDY DESIGN: Cross-sectional data on 14,983 adults from the Household Component of the 1996 Medical Expenditure Panel Survey. MAIN OUTCOME MEASURES: Receipt of recommended preventive care: blood pressure and cholesterol screening, flu shot, Papanicolaou test, mammogram, and dental visit. RESULTS: Controlling for other factors, analyses of risk profiles revealed a clear dose-response relationship with the receipt of preventive care regardless of race/ethnicity. In the total sample, having more risk factors was associated with a lower prevalence of, for example, receiving a cholesterol screening: 1 risk (PR=0.77; CI, 0.71-0.84), 2 risks (PR=0.56; CI, 0.49-0.64), and 3+ risks (PR=0.34; CI, 0.25-0.43). CONCLUSION: Sizeable disparities in the receipt of recommended preventive services were found in relation to increasing vulnerability risk profiles. Without attention to such co-occurring risks, it is unlikely that substantial gains will be made in reducing disparities in the incidence of and mortality from the most common preventable diseases in the United States.