Timothy Cordova, Law & Policy Scholar, JD Anticipated May 2021
The closure of Hahnemann University Hospital has sparked a vigorous debate about the state of our local health care system. Since Philadelphia is the largest city without a municipal hospital, residents feared that the closure of Hahnemann would have a devastating impact on vulnerable Philadelphians, prompting some commentators to propose that a new public hospital should open in Philadelphia. While the fears may be somewhat overblown, the city should take action.
However, opening a new municipal hospital is not the best use of the city’s resources. First, Philadelphia has an abundance of hospital beds per capita, beating the national and state average. Second, federal assistance for safety net hospitals is scheduled to decline, thus hampering the financial feasibility of a new municipal hospital. Finally, opening a new hospital might jeopardize the financial stability of Temple University Hospital, since fixed state funding will have to be spread between multiple safety net hospitals
Although it is impractical to open a new municipal hospital, the city should increase access to primary care to ensure the long-term well-being of all Philadelphians. The city should also ensure government assistance to Temple University Hospital—the city’s de facto public hospital—thereby guaranteeing its stability and sufficiency.
Improving Primary Care in Philadelphia
Philadelphia should look to expand primary care services in the city. By focusing on primary care, Philadelphia can ensure individuals have a reliable and affordable way to manage their acute and chronic illnesses. Primary care, long undervalued in the United States, is critical in preventing and managing chronic illnesses such as diabetes and hypertension. By prioritizing primary care, Philadelphia can avoid some of the 26,873 preventable hospitalizations a year that occur within its city limits.
Despite Philadelphia’s role as a hub for medical care, many individuals have a hard time finding a primary care physician. Philadelphia funds municipal health centers that provide a wide array of medical services, including primary care and prenatal care. Unfortunately, these health centers are overburdened; collectively, the nine clinics see 80,000 patients a year. The health centers’ popularity makes their waiting times prohibitively long. For example, at Health Center 10, there is a 6-month wait for a doctor’s visit. Meanwhile, West Philadelphia and Kensington are designated primary care shortage areas. To ensure Philadelphians get the care they need, the City should consider opening new health centers. In particular, the City should consider opening health centers in communities such as West Philadelphia and Kensington and study whether other communities might also benefit from one.
If someone does not want to wait for a health center appointment, they may have an even harder time finding a primary care provider. Some areas of Philadelphia, shockingly, are primary care deserts, meaning some communities lack the minimum number of primary care physicians needed for a healthy community. The 21.1% of Philadelphians with Medicaid have the hardest time finding a primary care provider. Only 2 in 3 of surveyed Philadelphia primary care physicians are willing to accept new Medicaid patients. If a Medicaid patient is able to find a primary care provider, they will face longer wait times for their appointment compared to individuals with private health insurance. Medicaid pays providers much less than other forms of insurance for their services, therefore driving down primary care providers’ salaries in low-income neighborhoods. To increase the supply of primary care providers in areas that need it the most, Philadelphia should consider supplementing Pennsylvania’s existing loan forgiveness program for primary care providers. This will help more doctors and their staff practice in areas where they are most needed while keeping their salaries competitive.
Temple University Hospital’s Role in City Healthcare
Temple University Hospital functions as the City’s de facto public hospital. Because the hospital is a state-related institution and serves many of the City’s Medicaid and uninsured population, Temple receives about $199 million a year in state and federal funding. But every year, Temple must negotiate with the state over the level of funding it receives. Although the state’s assistance to Temple has been steady, the state has cut off funding to safety net hospitals before, leading to their closure. In light of Hahnemann’s closure, the Commonwealth and the City should ensure that funding to Temple is stable and is in lockstep with the number of uninsured and Medicaid patients Temple sees. If the state ever reduces Temple’s financial support, the City should be ready with funds to guarantee its financial stability. Instead of building a new hospital, the City and state should solidify Temple’s role as the City’s public hospital.
This blog post should not be interpreted to imply that Hahnemann’s closure was a trivial event. The City lost a safety net hospital and a maternity ward. For Philadelphians who live near Hahnemann, they may now decide to stay at home rather than to seek care at all. But even attempted government interventions could not prevent Hahnemann from closing.
The City can still take action to improve the health of Philadelphians by reforming existing institutions rather than creating new ones. Reform means solidifying Temple’s status as the City’s de facto public hospital. Reform means improving access to primary care providers, a proven mechanism to reduce hospitalizations. Improving access will require multiple policy reforms, including opening more City health centers and providing loan forgiveness to providers who decide to practice in underserved areas. Regardless of how access is improved, the City can improve its residents’ wellness if it takes action now.