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Geographic Access to Primary Care

By August 31, 2016Commentary

The cornerstone to improving health care and health status is usually thought to be good primary care.  Good primary care requires relatively easy geographic access for consumers to primary care physicians or other clinicians.  A study published in Health Affairs examines the adequacy of primary care access in Philadelphia and whether various ethnic or minority groups are disproportionately impacted by access to those resources.   (HA Article)    While urban areas tend to have large numbers of physicians and other health resources when looked at as a whole, there can be dramatic variations across neighborhoods.  And while we often think of access difficulties in rural areas where people may have long drives to get to a physician, similar transportation issues can exist in urban areas, where many residents don’t have cars, mass transit may not be adequate and congestion can cause long travel times.  Philadelphia is the fifth largest US city, but has the highest rate of poverty.  The population is 42% African-American, 37% white and 12% Hispanic.  Using several data sources the researchers identified primary care resources in the city of Philadelphia and verified the location(s) at which these resources practiced.  They used census data to identify the number of adults in various neighborhoods and the racial composition of those neighborhoods.  The area unit of analysis was defined by a five-minute drive time radius under ideal conditions.

Census tracts in Philadelphia have significant levels of racial concentration, have significant variance in income level, and variance in insurance source or status.  The average ratio of adults to primary care provider was 1073 across Philadelphia, using the five-minute drive time radius, but the range was very large, from 105 adults to 10321.  Census tracts with high percentages of African-Americans were most likely to have very high ratios of adults to primary care resources, indicating low access.  While not quite as extreme an association, census tracts with high proportions of Hispanics were also more likely to have access issues.  Low-income areas, which often have high numbers of minorities in them, showed a similar pattern.  I think we all know why there are few primary care resources in these areas.  Clinicians likely perceive them as less safe environments, the patients may be perceived as more difficult, practicing in these neighborhoods may require longer commuting times and the opportunity for higher income is likely lower.  While it is not clear that minority clinicians are more apt to practice in a minority area, having more minority clinicians would undoubtedly be a positive.  Not clear how to resolve this problem in the short run.  There are companies focused on bringing more primary care resources to minority and low-income areas.  Certainly any funding for federally qualified health centers or similar medical facilities should be directed toward these geographic areas.  But to some extent, this lack of access is tied to broader problems of how to change these neighborhoods.


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