October 2008

A Replicable Model: New York City Uses Survey to Devise Plan to Increase Primary Care

An overused but accurate adage tells us “knowledge is power.” Nowhere is that maxim truer than when determining the most effective strategy for remedying New York’s health care problems—specifically in the field of primary care—at a time of fiscal crisis.

With an eye toward putting $26 million into expanding primary health care facilities in high-poverty areas over the next four years, the New York City Council and the New York City Department of Health and Mental Hygiene (NYCDOHMH) recently announced the results of a survey of 3,000 city residents measuring what patients identify as the most pressing problems in accessing primary care.

New York City's strategy employs three sets of metrics to ensure—during this financially difficult time—these reforms address the most crucial deficiencies for the most at-risk populations.

First, it invested in a comprehensive research program to determine which communities across the five boroughs are in most desperate need of additional primary care services.

Following the identification of 11 neighborhoods that include areas of four boroughs and all of Staten Island, the New York City Council and NYCDOHMH grew their knowledge base by polling 3,000 residents of these 11 underserved areas about specific barriers they face in receiving adequate primary care.

Long wait times, doctors’ inability to make timely appointments, a lack of listening skills from doctors and nurses, and prohibitively expensive cost of care were among patients’ top complaints.

Digging further into determining what steps must be taken to reform New York City’s primary care system—even as its bottom line continues to shrink—officials will hold public forums in each of the five boroughs to hear directly from the people in most critical need of primary care services.

Only after this third phase is completed will NYCDOHMH issue a request (likely in December) for proposals to expand services.

By acquiring this knowledge, New York City will have the best chance of getting these reforms right the first time, keeping costs down while providing services that cannot be delayed a day longer.

New York City’s approach should be replicated by other cities throughout the State. In addition, State government would be wise to follow New York City’s lead by taking a statewide perspective to addressing this challenge.

Facing perhaps an even more dire fiscal situation and with a much larger geographical terrain, the challenges for a statewide program of the same nature are obvious. Still, the New York State Department of Health and the Legislature sent a clear signal last year that they were aware of a robust primary care system’s myriad benefits, investing upwards of $300 million in primary care services.

Fiscal times have certainly changed, but using New York City’s model as a starting point, the State could deliver vital services to areas that most need at the lowest cost possible.