Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession
Abstract Background Federally qualified health centers (FQHCs) are integral to the U.S. healthcare safety net and uniquely situated in disadvantaged neighborhoods. The 2009 American Recovery and Reinvestment Act (ARRA) invested $2 billion in FQHC stimulus during the Great Recession; but it remains u...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Health Economics Review |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13561-024-00482-x |
| _version_ | 1797275956966064128 |
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| author | Elizabeth L. Tung Nour Asfour Joshua D. Bolton Elbert S. Huang Calvin Zhang Luc Anselin |
| author_facet | Elizabeth L. Tung Nour Asfour Joshua D. Bolton Elbert S. Huang Calvin Zhang Luc Anselin |
| author_sort | Elizabeth L. Tung |
| collection | DOAJ |
| description | Abstract Background Federally qualified health centers (FQHCs) are integral to the U.S. healthcare safety net and uniquely situated in disadvantaged neighborhoods. The 2009 American Recovery and Reinvestment Act (ARRA) invested $2 billion in FQHC stimulus during the Great Recession; but it remains unknown whether this investment was associated with extended benefits for disadvantaged neighborhoods. Methods We used a propensity-score matched longitudinal design (2008–2012) to examine whether the 2009 ARRA FQHC investment was associated with local jobs and establishments recovery in FQHC neighborhoods. Job change data were obtained from the Longitudinal Employer-Household Dynamics (LEHD) survey and calculated as an annual rate per 1,000 population. Establishment change data were obtained from the National Neighborhood Data Archive (NaNDA) and calculated as an annual rate per 10,000 population. Establishment data included 4 establishment types: healthcare services, eating/drinking places, retail establishments, and grocery stores. Fixed effects were used to compare annual rates of jobs and establishments recovery between ARRA-funded FQHC census tracts and a matched control group. Results Of 50,381 tracts, 2,223 contained ≥ 1 FQHC that received ARRA funding. A higher proportion of FQHC tracts had an extreme poverty designation (11.6% vs. 5.4%), high unemployment rate (45.4% vs. 30.3%), and > 50% minority racial/ethnic composition (48.1% vs. 36.3%). On average, jobs grew at an annual rate of 3.84 jobs per 1,000 population (95% CI: 3.62,4.06). In propensity-score weighted models, jobs in ARRA-funded tracts grew at a higher annual rate of 4.34 per 1,000 (95% CI: 2.56,6.12) relative to those with similar social vulnerability. We observed persistent decline in non-healthcare establishments (-1.35 per 10,000; 95% CI: -1.68,-1.02); but did not observe decline in healthcare establishments. Conclusions Direct funding to HCs may be an effective strategy to support healthcare establishments and some jobs recovery in disadvantaged neighborhoods during recession, reinforcing the important multidimensional roles HCs play in these communities. However, HCs may benefit from additional investments that target upstream determinants of health to mitigate uneven recovery and neighborhood decline. |
| first_indexed | 2024-03-07T15:21:29Z |
| format | Article |
| id | doaj.art-f89662ffbe4c421689c6c47ae3de9955 |
| institution | Directory Open Access Journal |
| issn | 2191-1991 |
| language | English |
| last_indexed | 2024-03-07T15:21:29Z |
| publishDate | 2024-01-01 |
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| series | Health Economics Review |
| spelling | doaj.art-f89662ffbe4c421689c6c47ae3de99552024-03-05T17:40:24ZengBMCHealth Economics Review2191-19912024-01-011411810.1186/s13561-024-00482-xImpact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recessionElizabeth L. Tung0Nour Asfour1Joshua D. Bolton2Elbert S. Huang3Calvin Zhang4Luc Anselin5Section of General Internal Medicine, Department of Medicine, University of ChicagoSection of General Internal Medicine, Department of Medicine, University of ChicagoBureau of Primary Health Care at the U.S. Department of Health and Human Services, Health Resources and Services Administration (at the time of authorship)Section of General Internal Medicine, Department of Medicine, University of ChicagoCenter for Spatial Data Science, University of ChicagoCenter for Spatial Data Science, University of ChicagoAbstract Background Federally qualified health centers (FQHCs) are integral to the U.S. healthcare safety net and uniquely situated in disadvantaged neighborhoods. The 2009 American Recovery and Reinvestment Act (ARRA) invested $2 billion in FQHC stimulus during the Great Recession; but it remains unknown whether this investment was associated with extended benefits for disadvantaged neighborhoods. Methods We used a propensity-score matched longitudinal design (2008–2012) to examine whether the 2009 ARRA FQHC investment was associated with local jobs and establishments recovery in FQHC neighborhoods. Job change data were obtained from the Longitudinal Employer-Household Dynamics (LEHD) survey and calculated as an annual rate per 1,000 population. Establishment change data were obtained from the National Neighborhood Data Archive (NaNDA) and calculated as an annual rate per 10,000 population. Establishment data included 4 establishment types: healthcare services, eating/drinking places, retail establishments, and grocery stores. Fixed effects were used to compare annual rates of jobs and establishments recovery between ARRA-funded FQHC census tracts and a matched control group. Results Of 50,381 tracts, 2,223 contained ≥ 1 FQHC that received ARRA funding. A higher proportion of FQHC tracts had an extreme poverty designation (11.6% vs. 5.4%), high unemployment rate (45.4% vs. 30.3%), and > 50% minority racial/ethnic composition (48.1% vs. 36.3%). On average, jobs grew at an annual rate of 3.84 jobs per 1,000 population (95% CI: 3.62,4.06). In propensity-score weighted models, jobs in ARRA-funded tracts grew at a higher annual rate of 4.34 per 1,000 (95% CI: 2.56,6.12) relative to those with similar social vulnerability. We observed persistent decline in non-healthcare establishments (-1.35 per 10,000; 95% CI: -1.68,-1.02); but did not observe decline in healthcare establishments. Conclusions Direct funding to HCs may be an effective strategy to support healthcare establishments and some jobs recovery in disadvantaged neighborhoods during recession, reinforcing the important multidimensional roles HCs play in these communities. However, HCs may benefit from additional investments that target upstream determinants of health to mitigate uneven recovery and neighborhood decline.https://doi.org/10.1186/s13561-024-00482-xNeighborhood disadvantageNeighborhood socioeconomic disadvantageFederally-qualified health centersRecessionLocal economies |
| spellingShingle | Elizabeth L. Tung Nour Asfour Joshua D. Bolton Elbert S. Huang Calvin Zhang Luc Anselin Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession Health Economics Review Neighborhood disadvantage Neighborhood socioeconomic disadvantage Federally-qualified health centers Recession Local economies |
| title | Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession |
| title_full | Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession |
| title_fullStr | Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession |
| title_full_unstemmed | Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession |
| title_short | Impact of 2009 American Recovery and Reinvestment Act (ARRA) health center investments on disadvantaged neighborhoods after recession |
| title_sort | impact of 2009 american recovery and reinvestment act arra health center investments on disadvantaged neighborhoods after recession |
| topic | Neighborhood disadvantage Neighborhood socioeconomic disadvantage Federally-qualified health centers Recession Local economies |
| url | https://doi.org/10.1186/s13561-024-00482-x |
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