All ETDs from UAB

Advisory Committee Chair

Robert Hernandez

Advisory Committee Members

Nathaniel Carroll

Amy Yarbrough Landry

William Opoku-Agyeman

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Over the past two decades, uncompensated care in U.S. hospitals has grown at a staggering rate and reached $46.4 billion in 2013. It began to decline in 2014, due to the passage of the Patient Protection and Affordable Care Act (ACA), but is now on the rise again. Uncompensated care is typically affected by policy and market factors such as legislative changes and an increase in the number of uninsured. While hospitals continue to serve as critical safety net providers, they are often not the only or most appropriate facility to serve the indigent in U.S. communities. Instead, federally qualified community health centers (FQHCs) were designed to provide care for the poor and uninsured. Accordingly, studies have shown that FQHCs reduce the number of costly emergency department visits and preventable hospitalizations. However, little work has been done showing the effect of FQHC penetration on hospitals' uncompensated care in a shared geographic area. In this study, FQHCs were posited as the health policy of interest to determine the effect of FQHC presence on uncompensated care in U.S. hospitals. Structural equation modeling was employed to compare uncompensated care in counties with FQHCs versus counties without an FQHC. In the final model, FQHCs, Medicaid iv expansion, race, high school education, uninsured population, household, unemployment rate, ED visits, and HMO penetration were statistically significant. The findings in this study revealed that counties with FQHC presence had higher uncompensated care. Further research is needed to understand why FQHCs' presence increases uncompensated hospital care. Moreover, a better understanding of healthcare utilization, such as patient visits and referral patterns, between FQHCs and hospitals may help to further inform researchers about this finding.



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