Despite Challenges, Health Centers Have High Satisfaction Rates

* Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers.* FQHC patients are more ethnically and racially diverse, more likely to be uninsured or on public insurance and more likely to be in poor health than the general population.

Newswise — Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers, reveals a new study in the Journal of Health Care for the Poor and Underserved.

The level of satisfaction shown by people who use the health centers was surprising, said lead author Leiyu Shi, DrPH, MBA, MPA, professor at the Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, M.D.

Because the centers treat a more vulnerable population, they often have a more difficult time addressing their patients' needs, he noted. Yet, the study shows that health centers appear to be reducing gaps in both quality of service and accessibility, he said.

Federally funded health centers are usually located in medically underserved communities, making them more likely to be either in inner city or rural areas, explained Shi.

Patients using these centers are more racially and ethnically diverse than the national population and more likely to be uninsured (39 percent compared to 17 percent) or to receive Medicare or Medicaid (54 percent compared to 27 percent) and to be in fair to poor health than the general population. But patients at FQHCs also reported better access to primary care and were more likely to be satisfied with the care they received (97.7 percent) than low-income Americans getting health care elsewhere (87.2 percent).

"This study tells us a lot about the role of a safety net system," said Georges C. Benjamin, M.D., executive director of the American Public Health Association in Washington, D.C. Federally qualified health centers have become like other health providers, but are more focused on primary care and preventive medicine, he noted. They are based in the community, with one federal requirement being that 51 percent of the members of their board of directors be from the community. They can bill private health insurance, Medicare and Medicaid, he said. "They have a range of ways for the completely uninsured to pay, usually on sliding fee scale," he added. "They are much more sensitive to the individual who does not have any money or the ability to pay it back."

Study authors suggest that there should be broader adoption of the FQHC model of care, which includes comprehensive and preventive primary care, a focus on vulnerable populations such as minorities and the uninsured, consumer participation, and cultural and linguistic sensitivity, among other features.

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Shi L, LeBrun-Harris LA, Daly CA, et al.: Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. J Health Care Poor Underserved. 24 (2013): 56–66