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J Health Care Poor Underserved. 2009 May;20(2):507-23. doi: 10.1353/hpu.0.0151.

Why do some health centers provide more enabling services than others?

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  • 1University of North Carolina at Chapel Hill, 1104F McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, USA. rswells@email.unc.edu


Enabling services (such as outreach, transportation, case management, and discharge planning) play a critical role in improving care for vulnerable populations. However, these services are generally not covered by third party payers, making them a challenge for safety net providers that are themselves often financially strained. The study reported here identified organizational and patient population characteristics associated with enabling services provided by community health centers funded by the Health Resources and Services Administration (HRSA). Lagged regressions on 2003-2004 data from HRSA's Uniform Data System (n=841) indicated that health centers with more managed care contracts and larger staffs provided both broader scopes of enabling services and higher volumes of these services. Grant revenue was negatively associated with the volume of enabling services; however, net revenue was positively associated with service volume. There were several positive associations between indicators of patient need and the scope and volume of enabling services.

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