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

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.