A Profile of Community Health Center Patients: Implications for Policy

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey, respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

Key Findings

• Compared to the low-income population overall, health center patients are more disadvantaged. Health center patients are poorer, more racially and ethnically diverse, and more likely to be unemployed and uninsured than the broader low-income population.
• Health center patients are twice as likely as low-income people overall to report being in only fair or poor health – 32% compared to 16%. The disparity in self-reported health status is apparent not only in the aggregate, but also within different insurance categories. For example, among both Medicaid beneficiaries and the uninsured, 1 in 3 health center patients report being in fair or poor health, compared to about 1 in 7 low-income individuals generally. These findings point to health centers as a locus of care for a largely low-income population with substantial health burdens.
• Rates of chronic conditions are higher among the health center patient population. Adult health center patients report having diabetes and asthma at rates 50% higher than the rates among all low-income adults. Their self-reported rate of hypertension is also higher.
• On key measures of preventive care and care management, health center patients fare as well as or better than the low-income population in general. Children who are health center patients are more likely than all low-income children to have received a check-up and a dental visit in the past year. Cancer screening rates are roughly similar between adult health center patients and all low-income adults, and adult health center patients with chronic diseases are at least as likely to receive chronic care services. However, mixed findings on cancer care and low rates of chronic care receipt point to health center difficulties in securing access to specialist care for patients.

Conclusion

Expanded coverage under the ACA promises health centers new revenues to expand and improve care, and newly insured patients stand to gain greater access to specialists as they join health plans with broader provider networks. In states that do not expand Medicaid, health centers and some 1 million uninsured health center patients will miss out on these improvements. Even as coverage expands, health centers will continue to serve many uninsured people and provide services not covered by insurance. Ongoing grant funding is needed to meet these costs. With expected changes in the health center population as many uninsured adults gain coverage, health centers may begin to strengthen their capacity to manage serious and chronic conditions and to enhance their adult preventive services to keep adults healthy and active.