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

[OBJECTIVE] The objective of this study was to estimate the association between an area's competition among Federally Qualified Health Centers (FQHCs) and cancer screening rates for cervical, breast, and colorectal cancers at an FQHC.

[METHODS] The study employed 2 secondary datasets between 2020 and 2022-the Health Resources and Services Administration's Uniform Data System and Unmet Need Score-to conduct a multivariable regression analysis on FQHCs' cervical, breast, and colorectal cancer screening rates in relation to the area's FQHC competition, measured as the Herfindahl-Hirschman Index, accounting for various FQHC-level and zip code-level control variables.

[RESULTS] The results indicated a significant negative association between the area's competition among FQHCs and cervical and colorectal cancer screening rates (Coef. = -.051, P < .01 and Coef. = -0.045, P < .01, respectively). There was no significant relationship found between breast cancer screening and the area's FQHC competition. Positive relationships were observed between screening rates, total cost per patient at an FQHC, and the number of FQHC patients.

[CONCLUSIONS] The study highlights the complexities of FQHC competition, showing that while competition may be associated with service improvements in other health care contexts, its impact on preventive care delivery in the FQHC setting may be more nuanced. Enhancing outreach, care coordination, and addressing resource limitations are key for FQHCs to boost cancer screening rates and improve health outcomes for vulnerable populations. Future research should explore competition's nuanced role further and identify strategies to mitigate its potential adverse effects on care quality.