Enabling Services Improve Access To Care, Preventive Services, And Satisfaction Among Health Center Patients

Yue D, Pourat N, Chen X, Lu C, Zhou W, Daniel M, Hoang H, Sripipatana A, Ponce NA
Source: Health Affairs
Publication Year: 2019
Patient Need Addressed: Care Coordination/Management, Patient satisfaction/engagement
Population Focus: Low income, Vulnerable/disadvantaged
Demographic Group: Adult, Racial and ethnic minority groups
Intervention Type: Service redesign
Study Design: Pre-post with Comparison Group
Type of Literature: White

Enabling services address a combination of social determinants of health and barriers to access to primary care and are intended to reduce health disparities. They include care coordination; health education; transportation; and assistance with obtaining food, shelter, and benefits. Empirical evidence of enabling services’ potential contribution to health outcomes is limited, which impedes their widespread dissemination. We examined how the receipt of enabling services influenced patient healthcare outcomes based on a nationally representative survey of patients served in 2014 at health centers funded by the Health Resources and Services Administration. We compared enabling services users and nonusers and found that enabling services were associated with 1.92 more health center visits, an 11.78-%age-point higher probability of getting a routine checkup, a 16.34-%age-point higher likelihood of having had a flu shot, and a 7.63-%age-point higher probability of patient satisfaction. Our results confirm the value of systematic delivery of enabling services in reducing access barriers and improving patient satisfaction.

Insights Results

Overview of article

  • This study examines how enabling services provided by the Health Resources and Services Administration (HRSA) health centers influence patients’ access to primary care, preventive services use, and satisfaction with care received. Enabling services can be defined as typically non-reimbursable “non-clinical services that aim to increase access to healthcare and to improve health outcomes.” Enabling services can include health education, language interpretation, and transportation

Methods of article

  • Authors used data for 2014 from the Health Center Patient Survey (HCPS), a cross-sectional survey of a nationally representative sample of patients served by health centers funded by HRSA grants. Authors also used data on organizational characteristics for 2014 reported by HRSA-funded health centers to the Uniform Data System
  • Authors included adults who reported the health center where they were interviewed as their usual source of care
  • The study assessed 4 outcomes that had direct theoretical association with enabling services: 1) Number of health center visits; 2) Whether patients received general physical exam or routine checkup; 3) Whether patients had received a flu shot; and 4) Whether or not patients would definitely recommend the health center to others


  • Patients receiving enabling services had more health center visits and a higher likelihood of receiving a glue shot on average when compared to nonusers. Users were also more likely to have had a routine checkup and to say that they would definitely recommend the health center to others
  • About 80% of the study population reported receiving at least 1 enabling service. The 5 most-used enabling services (descending order) were: 1) Care coordination; 2) Health education; 3) Free medication; 4) Help getting government benefits; and 5) Supportive counseling
  • Interestingly, the study found that assisting patients in obtaining health insurance was not related to significant changes in getting a flue shot among low-income, nonelderly adults. Additionally, the study found that the receipt of 1+ enabling services had a notable and robust association with the receipt of flu shots and checkups and satisfaction with care. These findings indicate that barriers to care are typically complex and interrelated, requiring a mix of enabling services

Key takeaways/implications

  • Overall, the study found that the receipt of one or more enabling services had a notable and robust association with the receipt of flu shots and routine checkups, as well as with satisfaction with care
  • These findings indicate that barriers to care are typically complex and interrelated, requiring a mix of enabling services. Additionally, findings suggest that health outcomes are likely determined by more than brief clinical interactions
  • Reimbursement and payment for enabling services must be considered as the current lack of a standard methodology for payment for enabling services imposes challenges for adequate reimbursement
  • Future research on enabling services is warranted specifically around 1) More precise, valid and reliable measures of self-reported use; 2) Use of longitudinal data with a stronger study design (e.g., randomized controlled trials) to allow for more robust estimates of the impact of enabling services; 3) Cost-effectiveness studies; and 4) Examination of reliable funding streams and US financing policies to support enabling services that add social determinants that drive patient health
  • Limitations to the study include potential selection bias, examination of use of any service instead of use of individual services, lack of direct measures of the impact of addressing social determinants of health, inability to assess whether enabling services use occurred before or after the outcomes, potential for recall bias and self-reported data, and potential lack of generalizability