Demographics of patients shift as Federally Qualified Health Centers expand

In a report published by JAMA Internal Medicine, it was found that the demographics of patients seen at Federally Qualified Health Centers (FQHCs) from 2005 and 2014 have shifted to where the population of young, low-income, uninsured or Medicaid-insured, racial and ethnic minority Americans increased more rapidly than other demographic groups.

Under the American Recovery and Reinvestment Act and the Affordable Care Act there has been a demographic shift in the demand for FQHCs’ healthcare and social services. The growing federal support of these centers and the implementation of the two expansions have been followed by two notable demographic shifts, the first occurred with the loss of employer-sponsored insurance during the 2008-2009 economic recession, and the second with the expansion of health care coverage under the Affordable Care Act, including 6.5 million persons insured through Medicaid.

“Current analyses examining the trajectory of the FQHC network’s patients predate those expansions, lack population adjustments, or focus on a single demographic variable,” wrote Julia B. Nath, of the University of Chicago, and colleagues. “We conducted a study to overcome these shortcomings by describing the changes in the demographics of patients seen by FQHCs over the past decade.”

The study analyzed data on patients seen at FQHCs in 50 states from 2005 to 2014 by using the Uniform Data System and examining the demographic characteristics of FQHC patients including race, ethnicity, income as a percentage of the federal poverty line, insurance status, and state of residence.

Overall the study showed many changes in FQHC demographics. The results showed the increase in lower-income populations served by FQHCs over that of higher income groups and the highest rate of use in FQHCs was found in the youngest populations, where the rate of 0- to 19-year-olds grew from 6 to 9 percent.

Proportions of minority and racial groups, largely Hispanic and black populations, seen by FQHCs also saw an increased rate of change. Demographics shifted for all populations: the white population increased 3.5-5.5 percent; black populations, 9.5-11.3 percent; American Indian and Alaska native populations, 7.8-10.0 percent; and Asian American population, 3-4.4 percent. The minority group with the largest growth rate was the population of Hispanic Americans, increasing from 11.2 percent in 2007 to 13.4 percent in 2014.

“We found that the proportion of young, low-income, uninsured or Medicaid-insured, and racial and ethnic minority Americans served by FQHCs between 2005 and 2014 increased slightly more rapidly than that of other demographic groups,” concluded Nath and colleagues. “These underserved groups represent the core populations that FQHCs are meant to serve. In addition, more than 17 percent of Medicaid and uninsured patients in the United States received care at FQHCs in 2014, which emphasizes the importance of an FQHC partnership in health policy changes aimed at those populations.”