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Location, Location, Location… Determines Access to Primary Care in Philadelphia

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Number of adults per provider within a five-minute drive time of each census tract.

As attention shifts away from people trying to get coverage under the Affordable Care Act, researchers have started examining some of the other elements that determine overall access to primary care — things like how close people live to providers, whether the provider accepts the patient’s insurance, and how easily someone can get a new patient appointment.

A new report
compiled by health policy researchers at the Perelman School of Medicine takes an in-depth look at the proximity issue. They compiled a database of 460 verified primary care providers in Philadelphia County who are within a 5-minute driving radius (about 1.5 miles) of neighborhoods throughout the city.

At first glance, the findings seem to be good news: overall supply of primary care in Philadelphia is sufficient. However, that only tells one piece of the story. The more concerning part of the findings are that in some of Philadelphia’s most affluent areas, there  is one primary care physician for every 300 adults; but in certain low-income neighborhoods, there are close to 3,000 adults for every primary care provider.

When you look at the variation in primary care across different parts of the city, there are 10 times more adults per primary care provider in some areas than others. This closer look reveals a big difference in access solely based on where someone lives.

And while having a primary care provider within a 1.5-mile radius of a person’s home may not seem significant, for those who rely on public transportation, it could be the difference between getting the care they need or being stuck in a cycle of poor health.

“Primary care access is essential to a high-functioning health care system, so it’s important to understand where doctors are located in relationship to where people live,” said the study’s lead author, Elizabeth J. Brown, MD, a Robert Wood Johnson Foundation Clinical Scholar, a fellow in Penn's Leonard Davis Institute of Health Economics (LDI), and a family physician. “The geographic disparities found in this report show just how important it is to look at neighborhood-level access, in addition to overall, city-wide access.”

Overall, the researchers found that the population-to-primary care provider ratio in the city is 863:1. But when they broke down the data by neighborhood, they identified six clusters of lowest access: Southwest, West, Northwest, Lower Northeast, Greater Northeast and South Philadelphia/Gray’s Ferry.

“Even though the city as a whole has a relatively high number of primary care providers, these neighborhood disparities tell us that perhaps the distribution of providers is the bigger issue,” said David Grande, MD, MPA, an assistant professor of Medicine, director of policy at LDI, and a report author.

So now that we know the disparities exist, what can be done? Part of the solution is awareness of the problem. The other part is taking action to fix it. The report, funded by the Independence Foundation, was commissioned by the Philadelphia Department of Public Health to measure geographic access to primary care and identify areas at greatest risk of insufficient access.

“Our hope is that the Philadelphia Department of Health will now use the methods developed and used for the report to periodically reassess primary care access in order to inform neighborhood and city-wide planning efforts,” said Brown.

After all, we’re at a point now with health reform where Grande says health departments need to begin monitoring how well the system is actually serving the population, and then making the changes necessary to improve access to primary care for all residents — no matter where they live.

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