Description

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.