The Impact of Public Health Policy: The Case of Community Health Centers

Abstract

The aim of this paper is to assess the impact of the Community Health Center (CHC) on health levels in the U.S. Using infant mortality as the underlying health indicator, a time series of large counties as the data set, and multivariate regression techniques, we investigate the extent to which the presence of a program in a county affects future mortality. We find that CHCs have negative and statistically significant impacts on white and black infant mortality rates. The centers have larger effects on black infant mortality than on white infant mortality. The reduction in the black infant mortality rate between 1970 and 1978 due to the CHC system amounts to one death per thousand live births or approximately 12 percent of the observed decline. This result is particularly striking in light of the wellknown higher infant mortality rate of blacks. A reduction in the excess mortality rate of black babies has been dentf1ed as a goal of public health policy for a number of years. Our results suggest that community health centers have the potential to make a substantial contribution to the achievement of this goal.

Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings

“…11,21,22 Studies using ecologic designs have also demonstrated that the establishment or expansion of health centers in an area is associated with long-term declines in mortality. 23,24 Recent high-profile studies of Medicaid have brought intense controversy over the cost of the program. 25 States that are considering expansion of their Medicaid programs are engaged in discussions of how to manage health care spending for newly insured patients.…”

The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans

“…In one of the earliest studies of this type, Goldman and Grossman (1988), who examine infant mortality rates in the 678 largest counties between 1970 and 1978, find that an increase in the number of CHCs is associated with an overall reduction in infant mortality rates, particularly among blacks (see also Shi et al 2003 and O’Malley et al 2005). Using a 1996 to 2006 county panel and a specification with clinic and year fixed effects, Lo Sasso and Byck (2010) provide the best evidence to date that increases in CHC funding raise service availability and staffing while reducing uncompensated care.…”

“…The handful that do focus on infants (Chabot 1971; Goldman and Grossman 1988; Shi, Macinko, Starfield, et al 2004; and Shi, Stevens, Wulu, et al 2004) or specific health conditions (Gordis 1973 for rheumatic fever; Dignan, Hall, and Hastings 1979 for cardiovascular disease; Hicks et al 2006 for asthma; Chin et al 2000 and Hicks et al 2006 for diabetes; O’Connor, Wagner, and Strogatz 1990 and Hicks et al 2006 for hypertension; Hedberg et al 1996). Our analysis is the first to consider the longer-term impacts of CHCs on mortality rates as well as to characterize heterogeneity in these effects by age group, race, and population density.…”

Evaluation of the impact of the Mother and Infant Health Project in Ukraine

“…However, when investigating separately the effect on poor and rural households, spending does play a role in improving infant health for those groups. Goldman and Grossman (1988) find that health-care spending and public policy programs in the US do have a significant impact on infant mortality, and argue that this impact runs through improvements in health of mothers, rather than the use of prenatal care per se. The evidence also shows that infant and child mortality and morbidity are determined by poverty and unemployment rate (Bhalotra, 2007;Currie and Grogger, 2002), parental education, urban residence, and maternal health in general (Buckley, 2003;Chou et al, 2007).…”