Primary Care in New York City

Health care - rather than sick care - requires preventive and primaryservices. With more than half of New York City communities facingsignificant shortages of primary care physicians who serve low-incomeNew Yorkers, those New Yorkers disproportionately rely on emergency roomservices for health care. Furthermore, 32% of the primary carephysicians who serve low-income New Yorkers base their practices in hospitals.

Faced with the hospital closures proposed in the BergerCommission report, many New Yorkers - especially those with low incomes- will lose a major source of primary care and will face increasedbarriers to accessing health care.Populations served by health centers show lower rates of costly healthconditions and lower rates of preventable hospitalizations when comparedto those who do not live within close proximity to a health center.

Uninsured people living close to a community health center are lesslikely to postpone or delay seeking needed care, and less likely to havevisited an emergency room, compared to other uninsured persons.The City's role should be to expand the primary health careinfrastructure for our residents to access preventive medicine.

Currently, about 62% of New York City zip codes have an inadequatenumber of primary care physicians. A ratio that represents adequateaccess is fewer than 2000 Medicaid enrollees per 1 full time equivalent(FTE) primary care physician, but more than 40% of New York City zip codes have more than 3000 Medicaid enrollees per 1 FTE.

Important Resources

Download the full Primary Care Initiative Report. (pdf)
Download a copy of the Concept Paper
View the press release about the Initiative.
See pictures from the press conference on the initiative.

Targeting High-need Areas

New York City's diverse communities suffer from disturbing healthdisparities. Poor New Yorkers are 4 times more likely to self-reportpoor health than are wealthy New Yorkers and life expectancy in theCity's poorest neighborhoods is significantly shorter than in wealthyareas. Residents of poor communities have consistently worse healthoutcomes than their neighbors in wealthier areas. This trend isespecially apparent in the treatment of chronic illnesses such asdiabetes and asthma that can best be managed in primary care settings.These communities are also, not surprisingly, the same areas that have ashortage of primary care physicians (and often a shortage of otherhealth care providers as well). Eleven communities have been targeted bythe initiative for expansion of services: south Bronx, central Bronx,north Brooklyn, central Brooklyn, Flatbush, east and central Harlem, theLower East Side, West Queens/ LIC/Astoria, Jamaica/Southeast Queens,Rockaway, and Port Richmond/Stapleton/St. George.

The Primary Care Initiative

To address primary health care shortages effectively, the City Council proposes an expansion of primary care capacity in the communities withthe most severe primary care shortages. Through fiscal year 2012, the Council proposes to support state-of-the-art health care facilities inthe communities with the most severe primary health care shortages. This initiative will expand existing health clinics, support the development of satellite clinics and build new health care facilities. Grants will be provided directly to clinics to build and improve infrastructure andto off set start-up operating costs.

The initiative consists of three parts:
* Community assessments were concluded this year (see report)
       * The New York City Council, with the help of HHC, DOHMH and our working group completed these community assessments. This working group included advocates, providers and community organizations and experts in the field. The Council would like to specifically thank Alianza Dominicana, Asian & Pacific Islander Coalition on HIV/AIDS, Bedford Stuyvesant Family Health Center, Brooklyn Perinatal Network, Caribbean Women's Health Association, Commission on the Public's Health System, Community Healthcare Network, Community Health Care Association of NY, Community Service Society of New York - NYC Managed Care Consumer Assistance Program, Hunter College, Institute for Urban Family Health, Korean Community Services of Metropolitan NY, Lehman College, Make the Road New York, New York City Council, Policy Division and Health Committee, New York City Department of Health and Mental Hygiene, New York City Health and Hospitals Corporation, New York City Office of the Deputy Mayor for Health and Human Services, New York Immigration Coalition, Primary Care Development Corporation, Project Hospitality, Ryan/Chelsea-Clinton Community Health Center, The Bronx Health Link, Urban Health Plan and William F. Ryan Community Health Center.
* Capital grants will be made to successful applicants during fiscal years 2009-2012.
* Expense grants will be made to successful applicants during fiscal years 2009-2012.

Providers that benefit from these grants will accept public health insurance, offer affordable services to the uninsured, endeavor toprovide culturally competent care, and operate at hours that areconvenient for patients. Beneficiaries will also be required to trackspecific data on health services provided.

What's next?

The Department of Health and Mental Hygiene released a concept paper forpublic comment which will help target funding awarded through theRequest for Proposals later this year. Come to a public forum in your borough to hear more and offer your comments.