Racial Disparities In Geographic Access To Primary Care In Philadelphia
- Elizabeth J. Brown ( [email protected] ) is the Harrington Clinician Scholar at the Value Institute and the Department of Family and Community Medicine at the Christiana Care Health System, in Newark, Delaware.
- Daniel Polsky is executive director of the Leonard Davis Institute of Health Economics and is the Robert D. Eilers Professor in Health Care Management and Economics at the Wharton School, both at the University of Pennsylvania, in Philadelphia.
- Corentin M. Barbu is a researcher in the Department of Environment and Agronomy at the French National Institute for Agricultural Research, in Paris.
- Jane W. Seymour is a doctoral candidate in the Department of Epidemiology at the Boston University School of Public Health, in Massachusetts.
- David Grande is an assistant professor of medicine at the Perelman School of Medicine and a senior fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
Abstract
Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care’s cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans.
