Safety Net Primary Care Demand and Supply Analysis April 2007 Community Clinics Advisory Committee (Alliance) Project Safety Net (St. Luke’s Episcopal Health Charities) Houston Health Services Research Collaborative (UTSPH)

Objectives Assess the overall gap in the County Identify areas with the largest gap Predict the impact of different strategies to close the gap

Estimated Demand Obtain latest estimates of the number of uninsured at the ZIP code level from UTSPH Obtain latest estimate of the average number of primary care visits per person per year from HCHD Multiply the number of primary care visits by the number of uninsured in each ZIP code Sum for the County and for each quadrant Quadrants defined according to former HCHD service areas

Estimated Supply Obtain latest estimate of primary care visits from Project Safety Net 70 clinics that provide free and/or discounted primary care at least 20 hours per week and serve as a medical home for the uninsured Primary care visits defined as clinic encounter when patient seen by physician or mid-level practitioner

Limitations Demand is overestimated since not all uninsured rely on safety net clinics for care Supply overestimates capacity since patients use clinics outside their quadrant Supply for the uninsured is based on unproven assumptions about payer mix Unmet demand of the uninsured underestimates primary care capacity needed since clinics cannot survive if only serving the uninsured Supply underestimates capacity since it does not include charity care of private physicians

2005 Primary Care Gap for Total Uninsured

2005 Primary Care Gap for Uninsured who are <100% of the Federal Poverty Level

2005 Primary Care Gap for Uninsured who are <200% of the Federal Poverty Level

Growth in supply may only keep pace with population growth Northeast quadrant growth in supply: 177,218 visits in 2005, 185,013 visits in 2006 (growth of 4.40%) Northeast quadrant growth in population: 786,399 in 2000, 884,329 in 2005 (growth of 12.45%)

Population growth by quadrant and for entire county