Access points for the underserved: primary care appointment availability at federally qualified health centers in 10 States

Med Care. 2014 Sep;52(9):818-25. doi: 10.1097/MLR.0000000000000184.


Background: Federally Qualified Health Centers (FQHCs) are a vital source of primary care for underserved populations, such as Medicaid enrollees and the uninsured. Their role in delivering care may increase through new funding allocations in the Affordable Care Act and expanded Medicaid programs across many states.

Objective: Examine differences in appointment availability and wait-times for new patient visits between FQHCs and other providers.

Research design: We use experimental data from a simulated patient study to compare new patient appointment rates across FQHC and non-FQHC practices for 3 insurance types (private, Medicaid, and self-pay). Trained auditors, posing as patients requesting the first available new patient appointment, were randomized to call primary care providers in 10 states in late 2012 and early 2013. Multivariate regression models adjust for caller-level, clinic-level, and area-level variables.

Study setting: The sample comprises 10,904 calls, including 544 calls to FQHCs.

Results: FQHCs grant new patient appointments at high rates, irrespective of patient insurance status. Adjusting for caller, clinic, and area variables, the Medicaid appointment rate at FQHCs is 22 percentage points higher than other primary care practices. Although the appointment rate difference between FQHCs and non-FQHCs is somewhat smaller for the self-pay group, FQHCs are much more likely to provide a lower-cost visit to these patients. Conditional on receiving an appointment, wait-times at FQHCs are comparable with other providers.

Conclusion: FQHCs' greater willingness to accept new underserved patients before 2014 underscores their potential key roles as health reform proceeds.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Appointments and Schedules*
  • Computer Simulation
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Patient Protection and Affordable Care Act
  • Primary Health Care / statistics & numerical data*
  • Random Allocation
  • Safety-net Providers / statistics & numerical data*
  • Vulnerable Populations / statistics & numerical data*