The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts

PLoS One. 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279. eCollection 2020.


Importance: Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED).

Objective: To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs.

Methods: Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010-2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010-13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses.

Results: In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp).

Conclusions: We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care Facilities / economics
  • Ambulatory Care Facilities / trends
  • Community Health Centers / economics
  • Community Health Centers / trends
  • Health Facilities / economics*
  • Health Facilities / trends
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Massachusetts
  • Medically Underserved Area
  • National Health Programs / economics*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Protection and Affordable Care Act / economics
  • Patient Protection and Affordable Care Act / statistics & numerical data
  • Patient Protection and Affordable Care Act / trends
  • Primary Health Care / economics
  • Primary Health Care / trends
  • Retrospective Studies
  • United States
  • Vulnerable Populations