Does Philadelphia have primary care deserts?

Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance.  That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care.  For health care reform to deliver on its promise, people need good access to primary care.

Last week, our team at the Leonard Davis Institute of Health Economics at the University of Pennsylvania released a report measuring primary care access by neighborhood. The report was commissioned by the Philadelphia Department of Public Health and funded by the Independence Foundation.

We found that some neighborhoods have 10 times more primary care providers nearby (as measured by the number of adults per provider within a 5 minute drive time) than other neighborhoods.  We chose short drive times because primary care needs to be convenient in order to be properly utilized.  We identified six geographic clusters where the availability of primary care was much lower than the rest of the city.  You can see those areas on a map published in the Inquirer last week.

Do people in these neighborhoods have adequate access to primary care? We can't say for sure, but we believe that they are at risk of being underserved. The City as a whole has enough doctors, but the disparity in where they're located, and thus the populations that they serve, is cause for concern. What should different stakeholders – health policymakers, area hospitals and importantly Philadelphia's new mayor – take away from our findings and do to address them?

First, the availability of primary care near people's homes varies tremendously by where people live. This finding shouldn't be ignored. The areas that had the fewest providers were areas with high minority populations.

Second, we need to take a deeper look at all six areas to find out if they really are primary care deserts. Do patients in these neighborhoods struggle to get appointments? Do they face long travel times that create obstacles to getting care? Do patients with certain kinds of insurance like Medicaid get turned away?

What we know now is that we should be worried about these six areas. Philadelphia Health Commissioner Dr. James Buehler called the report's findings "a starting point for a broader conversation",  and my colleague Liz Brown elaborated on the questions we'd like to explore further in a recent blog post.

What can our area hospitals (that also run large systems of primary care practices) do?  They should be trying to answer the same questions about access for ALL of the populations that they serve.  The Affordable Care Act requires non-profit hospitals to conduct triennial "community health needs assessments" to maintain their tax-exempt status. Hospitals closest to these six areas should assess whether the communities they serve have adequate access to primary care in those assessments, and should address any gaps they find.

And finally, what about that new mayor, what can he or she do? The new mayor should make sure that the Department of Public Health has the capacity and authority to play a growing role in monitoring the availability of health care in Philadelphia and identifying areas with unmet need. While city government can't be expected to fill in all of the holes in our local health care system, it can monitor the system so that these issues receive the attention they deserve.

In the process of making health care available, accessible, and affordable for all, no neighborhood should be left behind.

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Editor's Note: Cross-posted on the Voices@LDI blog of the Leonard Davis Instutute of Health Economics of the University of Pennsylvania.

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