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Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA's coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states. KEY TAKEAWAYSThe Affordable Care Act has led to a drop in uninsured rates among blacks and Hispanics, narrowing disparities with whites.Between 2013 and 2015, disparities narrowed on three key health care access measures: the percentage of uninsured working-age adults, the percentage of adults who skipped care because of costs, and the percentage of adults who lacked a usual care provider.Disparities were narrower in states that expanded Medicaid under the ACA than in states that did not expand.

Strengthening the evidence-policy interface is a well-recognized health system challenge in both the developed and developing world. Brokerage inherent in hospital-to-hospital partnerships can boost relationships between “evidence” and “policy” communities and move developing countries towards evidence based patient safety policy. In particular, we use the experience of a global hospital partnership programme focused on patient safety in the African Region to explore how hospital partnerships can be instrumental in advancing responsive decision-making, and the translation of patient safety evidence into health policy and planning. A co-developed approach to evidence-policy strengthening with seven components is described, with reflections from early implementation. This rapidly expanding field of enquiry is ripe for shared learning across continents, in keeping with the principles and spirit of health systems development in a globalized world.

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), an important source of care in low-income communities. A Commonwealth Fund survey asked health center leaders in 2013 about current and anticipated workforce challenges, as well as efforts under way to prepare for the increase in patients. The majority of FQHCs reported shortages of primary care doctors (56%), especially bilingual physicians (60%). Health centers are engaged in activities to meet the needs of new patients, with 53 percent pursuing integration of behavioral health and 31 percent hiring additional clinical staff. To help them provide quality care to more patients, FQHCs will require assistance to recruit additional personnel, particularly bilingual staff and mental health professionals, and to expand access to care through telehealth and other strategies.

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations. OVERVIEWFederally qualified health centers (FQHCs), also known as community health centers, provide comprehensive primary care, behavioral health services, and dental care to all patients regardless of their ability to pay or health insurance status. Located primarily in medically underserved areas, these centers are a core component of the health care delivery system for low-income and minority populations. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation's nearly 1,200 FQHCs operating in 8,500 sites. 1 In addition to health services, FQHC staff provide patients with insurance eligibility and enrollment assistance, case management, language interpretation, and transportation services. It is clear that these safety-net providers are a critical source of care for low-income and minority populations. 2 After Massachusetts implemented its health reform program in 2006, there was an increased demand for services at community health centers among newly insured low-and middle-income residents. 3 The Affordable Care Act (ACA) has the potential to do the same at FQHCs nationwide, raising questions about the ability of these centers to continue providing high-quality, cost-effective care.To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.