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

Abstract

This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance. (JEL H75, I12, I13, I18, I32, I38, J14)

Public Insurance and Mortality: Evidence from Medicaid Implementation

“…Furthermore, coverage and utilization were very close for categorically eligible children. Both the 1976 Survey of Income and Education and the Office of Economic Opportunity 11-City Survey (Bailey and Goodman-Bacon 2015) show that 90 percent of families on welfare who report Medicaid coverage in a given year also report Medicaid utilization.…”

Perspectives in Primary Care: A Conceptual Framework and Path for Integrating Social Determinants of Health Into Primary Care Practice

“…17 These early health centers focused on health promotion and education, seeking to address poor nutrition and other SDH. 17 The recognition that social determinants influence health fueled the creation of community-oriented primary care concepts in the 1940s, [18][19][20] the development of family medicine as a medical specialty in the late 1960s, 21,22 the passage of legislation to create the neighborhood Health Center Program in 1964 (predecessor to federally qualified health centers), 23 and the Alma-Ata declaration in 1978, which stated that "primary health care…is the first level of contact of indi-viduals, the family, and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first elements of a continuing health care process." 24 Primary care has a tradition of partnering with patients, communities, and public health professionals to attempt to address SDH, [25][26][27] yet the ability to act on SDH in medical care settings in a meaningful, systematic way has been constrained by a fee-for-service payment structure, a medical culture focused on treating disease rather than promoting health, and limited technologies, among other barriers.…”

Missing Work Is a Pain

“…where the coefficients of interest are π , which are event-study type estimates that measure the evolution of outcomes among individuals with joint pain reported around age 40 in the quarters before and after Vioxx enters and exits the market (see for example Jacobson et al, 1993;Autor, 2003;Bailey and Goodman-Bacon, 2015). The indicators for quarters in 1999 are omitted; thus, the π coefficients describe the evolution of the outcomes relative to 1999, before Vioxx entered the market.…”