Primary Care Development Corporation (PCDC) has released a new Points on Care issue examining primary care access in California. The growing primary care provider shortage compounds existing health inequities for California’s underserved and vulnerable populations as communities struggle in the COVID-19 pandemic to meet increased needs for health services.

As PCDC’s California team works to expand support for primary care practices through capital lending, clinical quality improvement, and advocacy initiatives, the Evaluation and Analytics team is examining gaps in access to and need for primary care. In a recent issue of the team’s data brief series, Points on Care, statewide patterns show disparities in access to primary care across California.

In a recent conversation with Kirsten Weisbeck, MPH, Health Research Analyst, the Points on Care issue was discussed.

What does this issue of Points on Care tell us about primary care in California?

Our report shows us clear patterns of primary care access across California. Given the complex nature of health care access, we measured primary care access with four indicators; primary care provider (PCP) availability, health insurance coverage, self-reported health status, and low-income status. These are some of the many factors that impact an individual’s access to quality primary care.

Similar to PCDC’s previous research findings, there were notable differences in availability of providers across the Golden State. Many rural counties had fewer providers than more populous counties. In fact, there are several counties with fewer than ten PCPs. The wide variation in PCP availability suggests many Californians may have difficulty finding a provider in close geographic proximity. We know that proximity to providers, particularly for older and disabled populations, is often a barrier to continuous access to care.

Were any of the findings particularly surprising to you?

There were – the stark disparities in primary care access between California’s largest cities was an unexpected finding. PCP availability is nearly three times greater in San Francisco than in Los Angeles County. The pattern that was seen across all measures fell into very clear strata – higher income, better health, fewer uninsured, and more PCPs were closely tied across the cities. San Francisco had the highest provider availability and income and lowest uninsured rates, whereas Los Angeles had the lowest provider availability and the highest uninsured and lowest income populations.

This finding has not been previously discussed in the context of California’s cities.  Our analyses identified both regional and intra-city socioeconomic disparities in health care access and health status.

What can we do with the findings?

These findings can support health advocacy efforts across the state and shed light on areas for further research. The measures in the report should be monitored over time to understand trends occurring at the population level.  Targeted, region-specific actions are needed to address the inequities in both rural and urban areas and to reduce health disparities across California, particularly in low-access areas identified in this report. Future work should explore the relationship between primary care access and different social and cultural dynamics of each city.