181346 Role of Geography in Access to Medicaid Primary Care: A Spatial Examination of Access in Philadelphia

Tuesday, October 28, 2008

Heather A. Klusaritz, MSW , School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA
Purpose: Estimates of uninsurance rates reached over 45 million in 2006. Medicaid expansions have been proposed to expand coverage. While expansions will reduce uninsurance rates access to care issues for Medicaid-dependent populations remain. Provider preferences for practice location and Medicaid participation combine to create communities with a dearth of primary care providers (PCPs). The spatial relationship between communities of high Medicaid recipient concentration and PCP practice location is examined.

Methods: Office locations for Medicaid participating PCPs were geocoded and mapped using ArcView GIS 9.2. Community health centers (CHC) and EDs were mapped as alternative care sites. Concentration of poverty and African American(AA) population were chosen as proxies for high Medicaid recipient concentration. Census data was used to map poverty and AA population distribution at the census block level. Availability of PCPs within 2- and 5-mile radii of census block centroids was examined.

Results: No clear relationship between Medicaid-participating PCPs concentration of poverty was discernable. A more distinct pattern emerged between AA concentration and Medicaid participating PCPs; these communities had few PCPs scattered throughout. Providers located within a 5-mile radius of census block groups with high AA concentration were CHCs or hospitals, not PCPs.

Implications: PCP scarcity indicates limited access to care. Given the connection between access to a regular care provider and health outcomes, this spatial relationship does not bode well for Medicaid consumers. Eligibility expansions must be coupled with efforts to encourage Medicaid participation and to locate practices in areas with high concentrations of Medicaid consumers.

Learning Objectives:
1.To evaluate geographic distribution of Medicaid primary care providers in urban areas. 2. To identify areas with spatial mismatch between Medicaid providers and consumers. 3. To apply GIS in planning for health care safety net strategies.

Keywords: Health Care Access, Geographic Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the sole analyst of data and sole author on forthcoming manuscript
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.