A primer on places of care Healthcare in New York City is similar to healthcare across the United States: People often receive care in community-based physician offices, community health centers (such as federally qualified health centers), or, sometimes, hospital outpatient departments. 5 Access to each of these places of care varies by patient race/ethnicity, ability to pay, insurance status, and neighborhood of residence. 6 For low-income, uninsured, and Medicaid patients, emergency departments have also become a source of non-emergency care, particularly in urban areas. Community health centers play an especially pivotal role in reducing health- care disparities by ensuring access to physical and mental healthcare in communities facing economic disadvantage and barriers to healthcare. 7 Overall, community-based usual sources of care, such as a doctor’s office or a regular primary care provider, promote access to high-value, proactive primary and preventive care. They provide long-term patient-provider relationships, which promote continuity and patient-centeredness, ultimately reducing morbidity and premature mortality and ensuring greater popu- lation health equity. 8 During the COVID-19 pandemic, primary care practices were on the frontlines of test- ing and treatment—even while facing enormous financial strain and operational challenges. Nonetheless, they were resilient, nimble, and innovative, and they recovered as the pandemic started to wane. 9 Findings Where do high-need New Yorkers go to receive healthcare? Doctors’ offices or health centers were the primary place where most high-need New Yorkers regularly received healthcare, regardless of economic disadvantage or period of the pandemic (Figure 1). However, economically disadvantaged New Yorkers were less likely than more advantaged New Yorkers to visit a doctor’s office as their primary place of care, especially in 2022. As the pandemic started to subside, 78% of economically disadvantaged New Yorkers went to a doctor’s office as their primary place of care, similar to 2021. By contrast, 93% of more-advantaged New Yorkers went to a doctor’s office or health center as their primary place of care, up from 86% in 2021. The gap in primary care access between the two groups effec- tively doubled, from 8 to 16 percentage points in 2021 and 2022, respectively. This change suggests that as levels of access among more-advantaged, high-need New Yorkers have recovered, those facing economic disadvantage have continued to experience persistent difficulties in having regular access to a doctor’s office or health center.
5 Green et al., “The ecology of medical care revisited.” 6 Forrest and Whelan, “Primary care safety-net delivery sites in the United States: a comparison of community health centers, hospital outpatient departments, and physicians’ offices.”; Hussein, Diez Roux, and Field, “ Neighborhood socioeconomic status and primary health care: usual points of access and temporal trends in a major U.S. urban area.”; Bliss et al., “Variation in participation in health care settings associated with race and ethnicity.” 7 Pourat et al., “HRSA-funded health centers are an important source of care and reduce unmet needs in primary care services.” Laiteerapong et al., “Health care utilization and receipt of preventative care for patients seen at federally funded health centers compared to other sites of primary care.”; Bruckner et al., “African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers.” 8 Starfield, Shi and Macinko, “Contribution of primary care to health systems and health.”; Mafi, Wee, Davis and Landon, “Association of primary care practice location and ownership with the provision of low-value care in the United States.”; Pourat et al., “In California, primary care continuity was associated with reduced emergency department use and fewer hospitalizations.”; Doescher, Saver, Fiscella and Franks, “Racial/ethnic inequities in continuity and site of care: location, location, location.” 9 Corlette, Berenson, Wengle, Lucia and Thomas, “Impact of the COVID-19 pandemic on primary care practices.”; Horstman and Lewis, “How primary care is faring two years into the COVID-19 pandemic.”
PLACES OF HEALTHCARE RECEIPT AMONG NEW YORKERS WITH HIGH HEALTHCARE NEED 5
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