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Community R esidential S egregation and the L ocal S upply of F ederally Q ualified H ealth C enters
Author(s) -
Ko Michelle,
Ponce Ninez A.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2012.01444.x
Subject(s) - ethnic group , metropolitan area , poverty , index of dissimilarity , medicine , logistic regression , zip code , american community survey , medicaid , census , health equity , gerontology , environmental health , community health , demography , geography , socioeconomics , public health , health care , economic growth , population , nursing , political science , law , economics , cartography , pathology , sociology
Objective To examine associations between community residential segregation by income and race/ethnicity, and the supply of f ederally q ualified h ealth c enters ( FQHC s) in urban areas. Data Sources and Study Setting Area R esource F ile (2000–2007) linked with 2000 U.S . Census on U.S . metropolitan counties ( N = 1,786). Study Design We used logistic and negative binomial regression models with state‐level fixed effects to examine how county‐level characteristics in 2000 are associated with the presence of FQHC s in 2000, and with the increase in FQHC s from 2000 to 2007. Income and racial/ethnic residential segregation were measured by poverty and the non‐white dissimilarity indices, respectively. Covariates included measures of federal criteria for medically underserved areas/populations. Principal Findings Counties with a high non‐ w hite dissimilarity index and a high percentage of minorities were more likely to have an FQHC in 2000. When we examined the addition of new FQHC s from 2000 to 2007, the effects of both poverty and non‐ w hite dissimilarity indices were positive and significant. Conclusions Residential segregation likely produces geographic segregation of health services, such that provider maldistribution may explain the association between residential segregation and FQHC supply. Metropolitan areas that fail to achieve greater integration of poor and minority communities may require FQHC s to compensate for provider shortages.