The primary care delivery system in New York's low-income communities: Private physicians and institutional providers in nine neighborhoods

Despite a recent policy emphasis on managed care as the preferred method of financing and delivering care to Medicaid beneficiaries and other indigent populations, there is little information on the availability or the characteristics of primary care providers in low-income neighborhoods. Data from two independent surveys of primary care were analyzed. A 1998 street canvass of each of nine neighborhoods identified 367 primary care offices and 567 private-practice primary care physicians. Survey data on primary care were collected from a total of 280 ambulatory care sites across the city in 1997 and 1999. Information on services, hours, and other data on primary care offered at sites in these nine neighborhoods was compiled to develop a profile of the primary care delivery system. There are relatively few private practice physicians providing primary care in these neighborhoods. While there are considerably more primary care physicians at the ambulatory care sites, there is a wide variation in supply across neighborhoods, driven largely by the presence of sizeable safety-net facilities in several of the neighborhoods. Several indicators of access to primary care across these neighborhoods show similar neighborhood variations. Without primary care availability, managed care's promise of greater access to quality care for low-income populations may fall short.