HEALTH CARE
Access and Provider Capacity
Availability of primary care providers in low-income communities
is a critical condition to assuring access to care. New York’s
low-income neighborhoods have long suffered from a significant shortage
of primary care providers, a major factor affecting people’s
ability to have a health care home and get the health care services
they need. CSS research and advocacy has highlighted the inadequacies
of the primary care network in low-income communities, and the ways
in which those failures affect people’s ability to get health
care.
RSVP pediatric unit volunteer
Photo by Mike Relph
Our survey of community residents in the Bedford-Stuyvesant neighborhood
in Brooklyn found that even when people had insurance and a health
care home, they still had trouble receiving care. This was especially
true when they got sick and needed to see a doctor right away. People
also had trouble if they needed care after working hours, as most
providers in that neighborhood do not have extended hours. These
problems with the health care system contribute to the community’s
on-going reliance on the emergency room as an important source of
care.
Our work on the availability of primary care providers in low-income
neighborhoods goes back nearly 15 years. In 1990, CSS issued a ground-breaking
report that documented a staggering shortage of primary care doctors
in poor neighborhoods. In 2000 we revisited the question of the
availability of primary care providers in low-income neighborhoods.
The original study found that as many as 500 more physicians were
needed for primary care in nine of New York's poorest neighborhoods
sounded an alarm and an immediate response from then-Mayor Dinkins’
leading to the establishment of the Primary Care Development Corporation.
The follow-up project provided evidence that the shortage of primary
care continues unabated.
While improvements had occurred over the decade, the study found
that over 300 new primary care physicians were needed to provide
a minimum standard of availability. The major reason for the continuing
shortfall is a financial one: physicians need a flow of patients
who can pay for care. Low-income communities have large numbers
of uninsured patients who pay little or nothing, coupled with large
numbers of Medicaid-covered patients whose reimbursement is dramatically
lower than the cost of providing care.
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