Specialty Care Access

Patients without health insurance, who may have a low income or live in under-resourced neighborhoods, face many challenges when accessing specialty health care services. Due to these systemic factors, Black Philadelphians are more likely to face barriers when accessing specialty care services resulting in reduced access to quality health care along the continuum of care and negative health outcomes.

Select Key Metrics on Access to Specialty Care

Wait time Patient Wait Times Across Specialties

Transportation wait times; clinic wait times (e.g., emergency department, HIV care, oncology, etc.); insurance approval of specialty services.

 access Specialty Care Access

Rate of referral to specialists; specialist workforce availability by neighborhood; telemedicine services use; costs of specialty services.

Background

Several areas in Philadelphia have significantly higher rates of individuals without insurance. Many of these same areas have high rates of Medicaid enrollment and are home to predominantly Black or Hispanic Philadelphians and households with lower incomes.

 

Map of Philly insurance status

Source: Staying Healthy - Access to Primary Care in Philadelphia, City of Philadelphia Department of Public Health | Data Source: American Community Survey, U.S. Census Bureau

SYSTEMIC DRIVERS OF DISPARITIES

A history of discriminatory housing policies and practices has left Philadelphia a highly segregated city. For individuals living in racially segregated neighborhoods, interlocking systems of structural racism influence opportunities for education, employment, and secure housing. 

As a result, Black Philadelphians are more likely to have lower incomes and to either not have health insurance or be enrolled in Medicaid rather than private insurance. This leads to increased wait times for appointments and financial barriers that limit access to specialty care services.

Insurance status and income also determine the type of care facilities a patient has access to. Thus, Black Philadelphians are more likely to receive care at public safety net hospitals than private care facilities, often at a detriment to their health. 

Even with access to necessary and high quality care, engagement in specialty care is especially difficult for individuals from historically disenfranchised racial/ethnic groups who may experience added barriers related to transportation, digital access and literacy, inaccessible communication tools, and inflexible work commitments that make scheduling and attendance additional challenges.

Ongoing Efforts in the Philadelphia Community

Temple is centralizing access to specialty care, consults, and outpatient appointments.

More than 85% of the patients served by Temple University Hospital are covered by government-based insurance programs including Medicare and Medicaid. In the face of the COVID-19 pandemic and with a significant need to maintain necessary access to care for their patient population, Temple reformatted their telemedicine remote monitoring platform using funds from an FCC grant to incorporate symptom diagnosis software, tablets, phones, and other telecommunications equipment to diagnose and treat patients who needed a consultation for specialty services or outpatient appointments. The program has resulted in increases in appointment adherence and overall patient experience.

Efforts listed here may be independent of Accelerate Health Equity. Check back to learn about a broader list of health equity efforts.