CH B AR THE LEONARD DAVIS INSTITUTE R ES E RI EF of HEALTH ECONOMICS 14 Penn LDI 20 16 . - No Racial Disparities in Geographic Access to Primary Care in Philadelphia Elizabeth J. Brown, Daniel Polsky, Corentin M. Barbu, Jane Seymour, and David Grande Health Affairs, August 2016 KEY FINDINGS: Although Philadelphia has an adequate supply of primary care providers overall, spatial analysis shows wide variation across neighborhoods, with stark racial disparities. This study identifies six low-access areas within the city LDI RESEARCH BRIEF that warrant attention. THE QUESTION from 105 to 10,321. When the authors mapped these ratios, six low-access areas emerged, defined as five or more Geographic access to primary care providers is usually contiguous census tracts with the lowest supply of providers. considered a problem of rural areas, rather than of more These areas of Philadelphia, which include 63 census tracts, densely populated urban ones. But the supply of primary care are mapped below. providers may be inadequate in certain neighborhoods even if the number of providers for the population is adequate for the city as a whole. The authors conducted a spatial analysis of census tracts in Philadelphia to assess the supply of primary care providers, quantify differences in supply that might contribute to disparities, and determine population characteristics associated with variations in geographic access. They calculated the ratio of adults-per-primary-care-provider in each tract using a five-minute travel time from the center of each census tract. They wanted to know if the overall number of providers in a city obscures significant differences across neighborhoods, and if so, whether low-access neighborhoods Philadelphia areas with the lowest levels of geographic access to are more likely to be found in areas with large concentrations primary care providers. (Source: Health Affairs, August 2016) of racial and ethnic minorities. Nearly one-third of tracts with concentrated African THE FINDINGS American populations (80% or more) were in low-access areas, compared to just 6% of tracts with less than 20% The study found that across 363 census tracts in Philadelphia, African American populations. Low-access areas had higher rates of uninsurance. After adjusting for sociodemographic the ratio of adults per primary care provider averaged 1,073, and insurance characteristics, the odds of being in a low- well within established benchmarks for an adequate supply. access area were 28 times greater for high-African American (The definition of Health Professional Shortage Area is tracts than low-African American tracts, and six times 3,500:1). However, supply varied widely by tract, ranging greater for high-Hispanic tracts than low-Hispanic tracts. Research to Improve the Nation’s Health System. DATA DRIVEN. POLICY FOCUSED. ldi.upenn.edu THE IMPLICATIONS including the largest commercial and Medicaid insurers in the region, the local department of public health, and This study shows the wide variation of geographic accessibility community health centers. Providers were quantified (head of primary care among different neighborhoods in a city that counts and effort level) through a telephone survey. They appears to have a sufficient amount of primary care providers calculated ratios of adults per primary care provider in overall, with stark racial differences. each tract, using a five-minute drive time from the center of the tract as a measure of access. This corresponded to an However, geography is not destiny. The study looked at where average of 1.4 street miles traveled. They used relatively people live in relationship to where the primary care practices short travel times given urban populations’ reliance on are; there are many other factors that play an important role in mixed modes of transportation, but the results did not differ determining whether people have adequate access to primary when they expanded the measure to an eight-minute drive care. It may be that people may not choose the care that is time. They identified clusters of census tracts with the lowest geographically closest, preferring instead to see a provider near supply. Using the American Community Survey 2008- LDI RESEARCH BRIEF their work, near where they used to live, or easily accessible by 2013 estimates, they examined census tract characteristics public transportation. such as age, race/ethnicity, household income, and rates of uninsurance. The researchers used multivariate logistic Nevertheless, a low supply of primary care providers in a regression to model the association of demographic neighborhood might mean that residents must travel farther characteristics with being in a low-access area. or wait longer, which creates additional barriers to primary care. Low-access areas are often neighborhoods with high Brown EJ, Polsky D, Barbu CM, Seymour J, Grande D. Racial concentrations of ethnic and racial minorities; the low supply Disparities in Geographic Access to Primary Care in Philadelphia. DOI: of primary care providers might exacerbate existing health 10.1377/hlthaff.2015.1612. Health Affairs, August 2016. disparities, especially as minority populations make the largest gains in insurance coverage through the ACA, if demand for LEAD AUTHOR: DR. ELIZABETH J. BROWN services increase as well. Elizabeth J. Brown, MD, MSHP is the The analysis does not point to the causes of these disparities, but it does highlight a factor that should be considered when Harrington Clinician Scholar in the Value assessing the adequacy of our health system. Providers and Institute and the Department of Family and policy makers could use similar methods when planning primary Community Medicine at Christiana Care Health care locations, such as federally qualified health centers. System in Wilmington, DE. She was previously a Robert Wood Johnson Foundation Clinical Scholar and LDI THE STUDY Fellow at Penn, where she conducted this study. Dr. Brown’s research focuses on the organization and delivery of primary The authors examined spatial variation in primary care access for care, especially to underserved populations. adults in 363 census tracts, or neighborhoods, in Philadelphia. They constructed a geocoded database of primary care providers (physicians, nurse practitioners, physician assistants, and community health centers) from multiple data sources, Connect With Us: ldi.upenn.edu Since 1967, the Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to data-driven, • ldi.upenn.edu/health-policysense policy-focused research that improves our nation’s health and health • @PennLDI care. Originally founded to bridge the gap between scholars in • www.youtube.com/user/LDIvideo business (Wharton) and medicine at the University of Pennsylvania, LDI now connects all of Penn’s schools and the Children’s Colonial Penn Center Hospital of Philadelphia through its more than 200 Senior Fellows. 3641 Locust Walk Philadelphia, PA 19104-6218 LDI Research Briefs are produced by LDI’s policy team. For more P: 215-898-5611 F: 215-898-0229 information please contact Janet Weiner at weinerja@mail.med.upenn.edu.