Which health centers got the most COVID relief funds?

During the height of the COVID-19 pandemic, about $23 billion flowed into U.S. federally qualified health centers, which provide primary care to underserved populations regardless of patients’ ability to pay. But where those funds went, and their impact has not been tracked. But one UW Medicine study – with results published in two papers - attempted to do that.  

The first part of the study, published in the August edition of the journal of Health Affairs, catalogued where the money went, as well as how and where it was spent. The second study, published online in the October/December issue of the Journal of Ambulatory Care Management, looked at how it was allocated to different populations and projects. 

“We think we are one of the first study to really dig into this issue and research, in a broad way, how much and where pandemic money was used across health centers”, said Bianca Frogner, senior author of both papers. Frogner is the director of the UW Center for Health Workforce Studies, and a professor of family medicine at the UW School of Medicine. Between 2020-2021, about $23.3 billion in pandemic response funding was distributed to 1,352 federally qualified health centers in the United States. It was used to help pay for vaccines, staffing, lost revenue, telehealth programs and services to approximately 30 million patients. The centers received amounts ranging from as little as $19 from one source of funding to $1.2 billion per center.

The research team merged a variety of databases, including statistics kept by the Department of Treasury and the Department of Health and Human Services. According to the Health Resources and Services Administration, money was distributed based on the number of uninsured patients, rurality, and the covid burden of each health center.

The first paper reported that funding did in fact go to health centers with sicker and more unhoused patients, centers with fewer physicians, rural centers and centers located in the South.

The second part of the study, published in the Journal of Ambulatory Care Management, continued the analysis.  

Focusing on funding that explicitly targeted health centers, the study found that the low end of funding was $213 per patient, while the highest funded health centers received an average of $1,331 per patient, or a sixfold higher amount. 

Dovetailing with findings in the first study, centers receiving less funding had more Medicaid patients, a younger patient population that was more ethnically and linguistically diverse and were more likely to be enrolled in Medicaid. 

In contrast, authors noted, health centers at the highest funding quartile were likely to be in rural areas and served more uninsured or unhoused patients. 

“Funding did matter in terms of operational capacity,” Frogner said. “At the beginning of the pandemic, those who received the least amount of funding did worse in terms of outcomes and infrastructure. Fewer vaccines were distributed, and telehealth was used less.”

Over time, the study noted, the inequities in funding stabilized. 

Now that pandemic response money has essentially dried up, and with the COVID-19 summer and fall surges are still with us, Frogner said that more attention needs to be paid to sustaining health centers, and planning for the next pandemic. 

“Though our studies find that many health centers received a significant short-term financial boost during the pandemic, health centers need long-term investments, such as with the Bipartisan Health Workforce Innovation Act, to sustain a workforce to deliver high quality primary care,” she said.

The study was done in collaboration with researchers at the University of South Carolina and Boston University.

For details about UW Medicine, please visit http://uwmedicine.org/about.