Physician Supply And Access To Care In Urban Communities

Abstract

PROLOGUE: One of the driving forces that has enabled managed care companies to prosper has been their ability to extract concessions from specialty physicians, who are in excess supply. But what impact has this bountiful supply had on people's access to needed care? Using data from urban areas in California, this paper attempts to quantify the impact of physician supply— mainly primary care physicians—on access. In this large state's urban areas, physicians are plentiful, and at first glance access to care appears to be enhanced by this. However, when the authors adjusted the data to account for underlying population characteristics, they found that other factors, such as income, insurance status, and race/ethnicity, were more likely to affect the likelihood of an urban Californian's having satisfactory access to care. Kevin Grumbach has done extensive work on topics related to physician supply. A practicing physician, he is an associate professor in the Department of Family and Community Medicine and the Institute for Health Policy Studies at the University of California, San Francisco (UCSF). He is director of research for the UCSF Center for the Health Professions and holds a medical degree from UCSF. Karen Vranizan is a senior statistician at the UCSF Primary Care Research Center. She holds a master's degree from the School of Public Health, University of California, Berkeley. Andrew Bindman, an internist, is an associate professor of medicine and of epidemiology and biostatistics at UCSF. He is acting chief of the Division of General Internal Medicine at San Francisco General Hospital. His medical degree is from Mount Sinai School of Medicine in New York City. ABSTRACT: This paper uses an analysis of survey data from urban Californians to determine whether patients' reports of access to care were associated with physician supply. On unadjusted analyses, higher levels of physician supply were associated with better access to care. However, this association was no longer apparent after adjusting for underlying population characteristics such as insurance status, income, and race/ethnicity. Poorer access to care in communities with lower physician supply appeared to be explained mainly by lack of health insurance and other population characteristics rather than by physician supply. We conclude that a more geographically equitable distribution of physicians in urban areas is unlikely to compensate for an inegalitarian system of health insurance.

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