Community Health Center Inter-Organizational Relationships

Open Access
Garcia, Decima Christine
Graduate Program:
Health Policy and Administration
Doctor of Philosophy
Document Type:
Date of Defense:
March 28, 2005
Committee Members:
  • Rebecca Wells, Committee Chair
  • Susan Diane Brannon, Committee Member
  • Kathryn H Dansky, Committee Member
  • Ann Echols, Committee Member
  • safety net providers
  • safety net
  • federally qualified health centers
  • partnerships
  • inter-organizational relationships
  • uninsured
  • community health center
  • typology
  • access to care
  • health care
This dissertation presents three related articles: (1) an overview of the key U.S. safety net providers and their changing environment, (2) insight into the collaborative efforts of a single type of safety net provider, the community health center (CHC), and the development of a partnership typology for use in measuring partnership outcomes; and (3) the impact of inter-organizational relationships (IORs) on access to care using a nationally representative sample of CHCs and the partnership typology. The overview includes a description of SNP patient populations and financing structure and changes to the safety net’s environment and financial support. In response to these changes, safety net providers have pursued IORs with each other in pursuit of gaining greater efficiencies and expanding access to care for their patients. The description of community health center IORs delves into the stated reasons and motivations for IOR formation, the types of IOR members and activities, and the reported outcomes of IORs. A qualitative and cross-sectional approach was taken using a sample of 51 California and Florida federally-funded CHCs. The final article addresses the following research questions: Do CHC IORs increase access to CHC services? What specific types of organizational partners and activities contribute to improved access? Do CHC IORs specifically improve access to specialty, dental, and mental/substance abuse treatment for CHC patients? Data for this study are from a nationally representative sample of the Bureau of Primary Health Care grant applications. A lagged multiple linear analysis was performed to test for the influence of IORs on access to care outcomes as measured by the number of CHC users and number of specialty care providers (i.e., dental, behavioral health, and other specialty care). The study results do not find that IORs improve access to CHC services, in general, or to specialty types of care. It is possible that IORs improve access to care, but do so indirectly through improvements in financial outcomes, such as through creating greater efficiency or by adding financial resources, that in turn enable CHCs to see more patients.