Consumer governance and the provision of enabling services that facilitate access to care at community health centers

Abstract

Background: Federally qualified health centers (FQHCs) are primary care clinics, governed by a consumer majority, which accept patients regardless of ability to pay and provide nonclinical enabling services that facilitate patients' access to care. Understanding how FQHCs decide which services to provide is important, because enabling services are not typically reimbursed.

Objective: To model enabling service provision as a function of FQHC board composition.

Methods: FQHC-level data were drawn from multiple years of the Uniform Data System (UDS) (2002-2007), and merged with county-level data from the Area Resource File (ARF) (2002-2007) and board data from FQHC grant applications (2003-2006). The scope and volume of enabling services an FQHC provides are modeled as a function of board composition, executive committee composition, the interaction between them, general time trends, and other FQHC and county-level controls.

Results: The proportion of consumers on the board does not affect the scope of enabling services, but the proportion of descriptive consumers (who resemble typical FQHC patients) on the executive committee is associated with a significant increase in the scope of enabling services a health center provides. Neither the proportion of consumers on the board nor the proportion of consumers on the executive committee affected the volume of enabling services provided.

Conclusions: Consumer governance, specifically on the executive committee, plays a small role in determining which enabling services an FQHC provides, but more work is needed to identify factors associated with variation in the scope and volume of enabling services across FQHCs.