Community residential segregation and the local supply of federally qualified health centers

Abstract

Objective: To examine associations between community residential segregation by income and race/ethnicity, and the supply of federally qualified health centers (FQHCs) in urban areas.

Data sources and study setting: Area Resource File (2000-2007) linked with 2000 U.S. Census on U.S. metropolitan counties (N = 1,786).

Study design: We used logistic and negative binomial regression models with state-level fixed effects to examine how county-level characteristics in 2000 are associated with the presence of FQHCs in 2000, and with the increase in FQHCs from 2000 to 2007. Income and racial/ethnic residential segregation were measured by poverty and the non-white dissimilarity indices, respectively. Covariates included measures of federal criteria for medically underserved areas/populations.

Principal findings: Counties with a high non-white dissimilarity index and a high percentage of minorities were more likely to have an FQHC in 2000. When we examined the addition of new FQHCs from 2000 to 2007, the effects of both poverty and non-white dissimilarity indices were positive and significant.

Conclusions: Residential segregation likely produces geographic segregation of health services, such that provider maldistribution may explain the association between residential segregation and FQHC supply. Metropolitan areas that fail to achieve greater integration of poor and minority communities may require FQHCs to compensate for provider shortages.

Figure 1

Residential Segregation in 2000 and the Gains in Local Supply of FQHCs from 2000 to 2007 Note. The figures plot the effect of residential segregation in 2000 on the number of new federally qualified health centers (FQHCs) gained from 2000 to 2007, for urban counties with high and low poverty rates. Low poverty = 6.2 percent residents with incomes < 100 percent federal poverty level (10th percentile); high poverty = 18.6 percent poor (90th percentile). (a) Income residential segregation; (b) non-white residential segregation.