Health Status and Access to Care Among Low-Income Washington, D.C. Residents

As part of the DCPCA Medical Homes project, an analysis of health indicators, insurance status, and hospital admissions in the District of Columbia finds that:

Residents of low-income areas of Washington, D.C. consistently have worse health outcomes and less access to health care than those who live in more affluent areas of the city. Residents in neighborhoods with medium to high poverty rates are more likely to have chronic diseases such as asthma, diabetes and hypertension and to be hospitalized for conditions that could be treated and managed in a primary care setting. They have lower insurance rates and are less likely to have a regular doctor or source of health care besides hospital emergency rooms.

There have been some improvements in the past few years, however, especially among youth and young adults. Rates of potentially avoidable hospitalizations among youth declined between 2000–2004. (Potentially avoidable hospitalizations are hospitalizations for conditions that, with appropriate primary care, should not become serious enough to require admission to a hospital.) These trends were strongest among youth living in high- and moderate-poverty ZIP codes. There was also a decline in potentially avoidable hospitalizations among young adults (ages 18–39). The timing of these downward trends coincides with the expansion of the District’s Medicaid program and the creation of the D.C. Health Care Alliance, suggesting that these programs may be improving health outcomes for low-income District residents by improving access to primary care.

Health planners need access to more and better data to monitor District residents’ health status, access to care, and the performance of the health care system. The lack of data is especially pronounced for children and youth, for whom the potentially avoidable hospitalization statistics are some of the only health data available. There is little information on children’s insurance or health status. Without better data for residents of all ages on potentially avoidable hospitalizations by hospital, emergency department utilization, quality of care, insurance status, access to care, and chronic and acute diseases, the city and other health care leaders are hampered in their ability to improve the delivery of primary medical care to low-income and uninsured District residents.

The high rates of chronic disease and avoidable hospitalizations in parts of the city point to a clear need for better access to high quality primary care. Community health centers—nonprofit health centers with a mission to provide care regardless of ability to pay—provide critical services but do not have the capacity to serve all of the city’s medically underserved residents. The Medical Homes D.C. project, launched by the D.C. Primary Care Association in partnership with the District government, Brookings Institution, RAND and numerous other partners, is in the early stages of a long-term initiative to strengthen the current network of community health centers and create a more effective system to deliver primary care to low-income and uninsured District residents.