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Primary Care Capacity Shortage & the Potential Impact of Hospital Closures

Primary Care Capacity Shortage & the Potential Impact of Hospital Closures

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Published by pcdc1993
New York State currently is engaged in a long-awaited policy discussion about the size and shape of its health care system. This is particularly meaningful now because resources are or will be available to support a restructuring of that system. A primary catalyst of this effort is the Commission on Health Care Facilities in the 21st Century. The Commission's final report, due at the end of 2006, will include specific recommendations on hospital and long-term care facility restructuring and closures. These recommendationsand a new Governor's response to themwill have significant implications for New York City.


A major gap in the Commission's charge is primary care, which represents the majority of community-based health services before and after hospitalization. To that end, the Primary Care Development Corporation (PCDC) and the New York City Health and Hospitals Corporation (HHC) conducted an analysis of primary care physician availability and population vulnerability in New York City.

The purpose of this analysis was to:

* Assess primary care physician capacity available to New York City's residents, particularly low-income New Yorkers;
* Determine how primary care physician availability may be affected by hospital restructuring/closures; and
* Identify considerations that policymakers should take into account to maintain access to care and to ensure that the health of low-income or vulnerable New Yorkers is not compromised when making hospital restructuring/closure decisions.


A Caveat


While a more detailed population-specific assessment is needed to make planning decisions for any particular community, this report is an important starting point in assessing the level of primary care physician capacity currently needed in New York City as well as capacity that may disappear as a result of hospital closures. Low income New Yorkers, which includes persons receiving public insurance, such as Medicaid; the uninsured; and underinsured are highly reliant on hospitals for primary care. We used Medicaid enrollees as a proxy for low income residents because the data available on a zip code level for physicians allowed us to extrapolate those physicians available to Medicaid patients but not the uninsured or underinsured. This results in an undercount of low-income residents since this proxy excludes the number of uninsured or underinsured low-income New Yorkers, which is significant as one in four non-elderly residents of New York City1.7 million personswere uninsured in 2002-2003.
New York State currently is engaged in a long-awaited policy discussion about the size and shape of its health care system. This is particularly meaningful now because resources are or will be available to support a restructuring of that system. A primary catalyst of this effort is the Commission on Health Care Facilities in the 21st Century. The Commission's final report, due at the end of 2006, will include specific recommendations on hospital and long-term care facility restructuring and closures. These recommendationsand a new Governor's response to themwill have significant implications for New York City.


A major gap in the Commission's charge is primary care, which represents the majority of community-based health services before and after hospitalization. To that end, the Primary Care Development Corporation (PCDC) and the New York City Health and Hospitals Corporation (HHC) conducted an analysis of primary care physician availability and population vulnerability in New York City.

The purpose of this analysis was to:

* Assess primary care physician capacity available to New York City's residents, particularly low-income New Yorkers;
* Determine how primary care physician availability may be affected by hospital restructuring/closures; and
* Identify considerations that policymakers should take into account to maintain access to care and to ensure that the health of low-income or vulnerable New Yorkers is not compromised when making hospital restructuring/closure decisions.


A Caveat


While a more detailed population-specific assessment is needed to make planning decisions for any particular community, this report is an important starting point in assessing the level of primary care physician capacity currently needed in New York City as well as capacity that may disappear as a result of hospital closures. Low income New Yorkers, which includes persons receiving public insurance, such as Medicaid; the uninsured; and underinsured are highly reliant on hospitals for primary care. We used Medicaid enrollees as a proxy for low income residents because the data available on a zip code level for physicians allowed us to extrapolate those physicians available to Medicaid patients but not the uninsured or underinsured. This results in an undercount of low-income residents since this proxy excludes the number of uninsured or underinsured low-income New Yorkers, which is significant as one in four non-elderly residents of New York City1.7 million personswere uninsured in 2002-2003.

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Published by: pcdc1993 on Aug 23, 2009
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02/07/2013

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A PRIMARY CARE CAPACITY SHORTAGE IN NEW YORK CITY&THE POTENTIAL IMPACT OF HOSPITAL CLOSURES
A REPORT PREPARED BYTHE PRIMARY CARE DEVELOPMENT CORPORATION &THE NEW YORK CITY HEALTH AND HOSPITALS CORPORATIONSEPTEMBER 2006
Nancy Lager, MPH, MSUPDona Green, MBAVictor KimDeborah Zahn, MPH
 
Page II
A Primary Care Capacity Shortage in New York City& the Potential Impact of Hospital Closures
 ACKNOWLEDGEMENS We wish to thank the ollowing individuals or their insight and assistance in preparing this analysis:Ronda Kotelchuck, MRP, Executive Director, Primary Care Development CorporationSta rom the Center or Health Workorce Studies, State University at Albany, specically, JeanMoore, MSN, Director; Robert Martiniano, MPA, MPH, Project Director; and Maria Kouznetsova,MPH, PhD, Program Research Specialist John C. Billings, JD, Associate Proessor o Health Policy and Public Service, Robert F. WagnerGraduate School o Public Service at New York University, and Director, Center or Health andPublic Service ResearchFor additional copies o this report or or more inormation, please contact Deborah Zahn at212-437-3942 or dzahn@pcdcny.org.
 
Page III
A Primary Care Capacity Shortage in New York City& the Potential Impact of Hospital Closures
Table of Contents
 ACKNOWLEDGEMENTS IIEXECUTIVE SUMMARY 1INTRODUCTION 4FINDINGS 5RECOMMENDATIONS 13METHODOLOGY & DATA SOURCES 15 APPENDICES 17TABLES1 Primary Care Physicians Available to All and to Low-Income Only New Yorkers 52 NYC Emergency Room Utilization by Borough, 2005 7MAPS1 NYC Primary Care Physician Shortage Areas for Medicaid-Enrolled Residents 62 NYC ACS Admission Rates for 0-17 Population 83 NYC ACS Admission Rates for 18-64 Population 94 NYC Primary Care Physician Shortage Areas If No Hospital-Based Physicians Available 12 APPENDICES  A Primary Care Physician Shortage Areas for Medicaid-Enrolled Residents, by Borough 17Primary Care Physician Shortage Areas for Medicaid-Enrolled Residents, by Zip Code 18B Primary Care Physician Shortage Areas for Medicaid-Enrolled Residents,Travel Adjusted 19C Hospitals in NYC 20D Comparison of High ACS Admission Areas and Designated HPSAs in NYC 21

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