Penn report on health care recommends a new clinic in Lower Northeast

Efforts that could lead to the biggest expansion in Philadelphia's city health centers in a half-century took a key step forward this week with the release of a report showing that the medical need far outstrips available services in and around the Lower Northeast.

The report, a neighborhood case study by health-economics experts at the University of Pennsylvania, found what it called "unmet need" for primary-care services in the Northeast as a whole. It placed particular urgency on three zip codes - 19111, 19120, and 19124 - that in the last decade have experienced major demographic shifts.

The authors recommended that a new clinic - a city-run health center or a community center managed by nurses or physicians - be developed near where those zip codes intersect, which would be in or around Lawncrest.

The Philadelphia Department of Public Health operates eight health centers around the city, and half of the 340,000 patient visits for the year that ended June 30 were from people who had no insurance. At the only center in the Northeast, at Cottman Avenue near Bustleton, new adult patients must wait eight to nine months for an appointment, the longest in the city.

Health Commissioner Donald F. Schwarz has been working behind the scenes for several years to address the Northeast's health needs.

"We are not able as the city to afford a new health center at this point. So, trying to figure out how to make it happen is my task," said Schwarz, who cochairs the nonprofit that released the report Thursday. He did not attend the news conference.

An $80,000 grant for planning that would be needed to move forward is listed as approved on a federal health-resources website, although the city has not received official notification, Schwarz said Friday. The federal health-care overhaul included more money for local clinics, but how much would survive the deficit debate in Washington was unknown.

The new report is part of the lengthy process required to document need and gain federal support for either a city or a community center. It will be presented to the community for discussion at a meeting at 5:30 p.m. Oct. 4 at Friends Hospital, 4641 Roosevelt Blvd.

Winning neighborhood support is a critical next step. "Communities feel strongly about property values," Schwarz said, and must be actively involved in the discussion: "Where would be a good spot, where would be a bad spot, what are the issues?"

The time line for opening a new center would likely be 18 months to several years, at a cost of perhaps $8 million to $20 million, Schwarz said.

He said he would support a city-run center or a community center - or both - but noted that a city center would also require new operating funds to subsidize services that were not reimbursed by Medicaid, Medicare, or private insurance. City-run health centers typically serve higher percentages of uninsured patients than independent community centers do.

The city's eight centers have roots in mother-baby clinics that Philadelphia established to provide clean milk following a 1909 report that one-third of all infants in the city died before their fifth birthday. Epidemic summer diarrhea was a leading cause of childhood death.

The last big expansion was in the 1960s, in response to a decline in primary-care services, according to a city history of the health department. The clinics became comprehensive primary-care centers in the late 1970s, after Philadelphia General Hospital was closed.

The report released Thursday estimated "unmet" health-care needs using a new model that balanced two sides of the equation: the likely need of the population vs. availability of primary-care providers.

Need was based on a mix of factors - low income, low level of education, no health insurance, and no usual source of health care - that are available in population databases and are known to increase health risk.

Availability came from a survey that found that, among other things, just 14 percent of primary-care practices - including three community health clinics and the city health center - were accepting new patients in the largest Medicaid plan.

The Northeast is home to about a quarter of Philadelphia's population, but it is served by only the four city and community clinics - one of which is a women's health center - while the rest of the city has 33, said Anje Van Berckelaer, a physician at a community health center, who worked on the report as a Robert Wood Johnson Clinical Scholar at Penn.

The mismatch is partly historical: City and community health centers generally operate in the poorest, most medically underserved areas.

"The population of Northeast Philadelphia has changed dramatically in the last 10 years, and the available health-care resources just haven't kept pace with the demand for services," Van Berckelaer said. The gap is greatest at the southern end, she said, even though all four of the public health centers are located near there.

In Olney, for example, an Inquirer analysis of Census data shows that income declined 25 percent between 1999 and an average of the years 2005 to 2009. (The Census changed its data-collection methods in the interim.) Frankford was down 22 percent; Juniata Park/Feltonville, 20 percent; Oxford Circle/Castor, 18 percent; and Lawncrest, 8 percent.

All but Olney experienced population growth over that period, and Oxford Circle/Castor grew 15 percent. At the same time, the white population was down at least 50 percent in each of those neighborhoods.