Federally Qualified Health Center Access and Emergency Department Use Among Children

OBJECTIVE: To determine whether increasing access to federally qualified health centers (FQHCs) in California was associated with decreased rates of emergency department (ED) use by children without insurance or insured by Medicaid. METHODS: We combined several data sets to longitudinally analyze 58 California counties between 2005 and 2013. We defined access to FQHCs by county using 2 measures: FQHC sites per 100 square miles between 2005 and 2012 and percentage of Medicaid-insured and uninsured children served by FQHCs from 2008 to 2013. Our outcome was rates of ED use by uninsured or Medicaid-insured children ages 0 to 18 years. To determine the effect of changes in FQHC access on the outcome within a county over time, we used negative binomial models with county fixed effects and controls for preselected time-varying county characteristics and secular trends. RESULTS: Increased geographic density of FQHC sites was associated with <= 18% lower rates of ED visits among Medicaid-insured children and <= 40% lower ED utilization among uninsured children (P = .05 and P < .01, respectively). However, the percentage of Medicaid-insured and uninsured children seen at FQHCs was not associated with any significant change in ED visit rates among Medicaid-insured or uninsured children. CONCLUSIONS: Whereas increased geographic FQHC access was associated with lower rates of ED use by uninsured children, all other measures of FQHC access were not associated with statistically significant changes in pediatric ED use. These results provide community-level evidence that expanding FQHCs may have a limited impact on pediatric ED use, suggesting the need to explore additional factors driving ED utilization.