Reducing Disparities in Access to Primary Care and Patient Satisfaction: The Role of Health Centers

Background: Disparities in access to primary care in different types of health care settings are found to be due to race/ethnicity, health insurance, income, and health needs. The purpose of this study is to examine the experience of primary care by patients seen at health centers (HCs) compared to mainstream healthcare settings such as physicians' offices (POs), HMOs, and hospital outpatients (HOs). The focus is on racial/ethnic (predisposing), health insurance, income (enabling), and health (need) disparities, and the role of the healthcare system in overcoming these.

Methods: Comparative effectiveness study based on cross-sectional analyses of two nationally representative surveys. For patients seen at HCs, the 2009 Health Center Patient Survey was used. The survey, sponsored by the Health Resources and Services Administration, has a probability sample of 4,562 patients representing over 13 million health center medical patients seen during 2008. For patients seen at other healthcare settings, the 2008 NHIS was used. To reflect the design of the health center patient survey, only respondents with at least one physician visit in mainstream healthcare settings (n=21,545) were included. Similar measures of primary care accessibility (e.g., usual source of care or USC, unable or delayed in getting needed medical care, unable to get dental care, unable to get mental care, unable to get prescription drugs) were used in both analyses. In addition to race, insurance, income, and health status, other covariates in the multivariate analyses were age, gender, education, marital status, employment, limitation and disability, and residential region.

Results: Patients seen at HCs experienced comparable or better accessibility to primary care compared to other settings. Whereas there were no racial/ethnic and health-status related disparities and limited insurance-related disparities noted in HC settings, significant disparities (racial/ethnic, insurance, and income) existed in all other healthcare settings. These national-level disparities (two-folds for racial/ethnic groups and three-plus-folds for insurance and income groups) persisted after controlling for other patient sociodemographic characteristics.

Conclusions: Patients seen at HCs report comparable or better accessibility to primary care compared to other healthcare settings. Moreover, unlike other healthcare settings where significant disparities existed in primary care quality among patients with different racial/ethnic, insurance, and income groups, few disparities were noted among HC patients. As safety-net providers for uninsured and vulnerable populations, HCs provide high-level of accessibility to primary care and overcome healthcare disparities.