Working Paper: NBER ID: w21648
Authors: Suhui Li; Avi Dor; Jesse M. Pines; Mark S. Zocchi; Renee Y. Hsia
Abstract: In order to better understand what threatens vulnerable populations’ access to primary care, it is important to understand the factors associated with closing safety-net clinics. This paper examines how a clinic’s financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012. We use a discrete-time proportional hazard model to assess relative hazard ratios of covariates, and a random-effect hazard model to adjust for unobserved heterogeneity among PCCs. We find that lower net income from patient care, smaller amount of government grants, and lower productivity were associated with significantly higher risk of PCC closure. We also find that federally qualified health centers (FQHCs) and non-FQHCs generally faced the same risk factors of closure. These results underscore the critical role of financial incentives in the long-term viability of safety-net clinics.
Keywords: safety-net clinics; healthcare access; clinic closures; financial pressures; community characteristics
JEL Codes: D22; I11; L31
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| lower net income from patient care (G29) | higher risk of clinic closure (I11) |
| smaller amounts of government grants (H81) | increased risk of clinic closure (I11) |
| increased clinic productivity (O49) | lower risk of clinic closure (I11) |
| more visits per FTE staff (M51) | decreased risk of clinic closure (I14) |
| greater number of primary care physicians per capita (I11) | higher risk of clinic closure (I11) |
| higher net patient income (D31) | lower risk of clinic closure (I11) |
| greater productivity (O49) | lower risk of clinic closure (I11) |