Association Between Regional Competition and Cancer Screening Rates at Federally Qualified Health Centers

Seongwon Choi ¹, Aizhan Karabukayeva , Ganisher Davlyatov

⁰Author Affiliations: Department of Management, College of Business and Economics, California State University Los Angeles, Los Angeles, California (Dr Choi); Department of Health Administration & Policy, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Drs Karabukayeva and Davlyatov); and School of Health and Applied Human Sciences, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina (Dr Opoku-Agyeman).

The Journal of Ambulatory Care Management +

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December 1, 2025

View abstract on PubMed

Summary

Federally Qualified Health Center (FQHC) competition negatively impacts cervical and colorectal cancer screening rates. Breast cancer screening was not significantly affected, suggesting nuanced effects on preventive care delivery.

Area Of Science

Health Services Research
Public Health
Health Economics

Background

Federally Qualified Health Centers (FQHCs) are crucial for providing primary care to underserved populations.
Understanding the impact of market competition on FQHCs' preventive service delivery is essential for optimizing cancer screening rates.

Purpose Of The Study

To examine the association between FQHC competition and cancer screening rates for cervical, breast, and colorectal cancers.
To analyze how the Herfindahl-Hirschman Index (HHI) of FQHC competition relates to screening performance.

Main Methods

Utilized secondary data from the Health Resources and Services Administration's Uniform Data System (2020-2022).
Conducted multivariable regression analysis on FQHC screening rates, controlling for FQHC-level and zip code-level factors.
Measured FQHC competition using the Herfindahl-Hirschman Index (HHI).

Main Results

A significant negative association was found between FQHC competition and cervical cancer screening rates (Coef. = -0.051, P < .01).
FQHC competition also showed a significant negative association with colorectal cancer screening rates (Coef. = -0.045, P < .01).
No significant relationship was observed between FQHC competition and breast cancer screening rates.

Conclusions

FQHC competition has a complex and nuanced impact on preventive care, specifically cancer screening.
Strategies like enhanced outreach and care coordination are vital for FQHCs to improve screening rates among vulnerable populations.
Further research is needed to understand competition's role and develop interventions to maintain or improve care quality in FQHCs.

Keywords:

Federally Qualified Health Centers cancer screening preventive care

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