Access to Healthcare in the Bay Area

Authors: Jose Covarrubias, Yvette Morales, Quierra Shugart, Andrea Arauza Rivera

Background

Now more than ever, access to healthcare is at the forefront of people's minds. The COVID pandemic has brought to our attention the ways in which access to healthcare is lacking in many communities. In this project we investigate the healthcare shortages in the Bay Area.

The data and shortage classifications we discuss here are those of the Health Resources and Services Administration (HRSA) [1]. The HRSA has an algorithm that assigns areas scores based on access to primary care, dental care, and mental health care. The HRSA refers to these scores as the Health Professional Shortage Area (HPSA) scores. We note the unfortunate resemblance between the two acronyms HRSA (the organization) and HPSA (the shortage area score).

The Primary Care HPSA score is based on a 0 to 25 scale and incorporates the following components [1]:

Population-to-Provider Ratio [10 points max]
Percent of population below 100% Federal Poverty Level (FPL) [5 points max]
Infant Health Index (based on the higher of Infant Mortality Rate (IMR) or Low Birth Weight (LBW) Rate) [5 points max]
Travel time to Nearest Source of Care (NSC) outside the HPSA designation area [5 points max]

The Dental Care HPSA score is based on a 0 to 26 scale and incorporates the following components [1]:

Population-to-Provider Ratio [10 points max]
Percent of population below 100% Federal Poverty Level (FPL) [10 points max]
Water fluoridation status [1 point max]
Travel time to Nearest Source of Care (NSC) outside the HPSA designation area [5 points max]

The Mental Health Care HPSA score is based on a 0 to 25 scale and incorporates the following components [1]:

Population-to-Provider Ratio [7 points max]
Percent of population below 100% Federal Poverty Level (FPL) [5 points max]
Elderly Ratio (percent of people over age 65) [3 points max]
Youth Ratio (percent of people under age 18) [3 points max]
Alcohol Abuse Prevalence [1 point max]
Substance Abuse Prevalence [1 point max]
Travel time to Nearest Source of Care (NSC) outside the HPSA designation area [5 points max]

We now discuss an additional scoring that determines Medically Underserved Areas/Populations MUA/P. This score is calculated for areas throughout the country on a 0-100 scale. An area or population with a score of 62 or higher is designated as an MUA/P. This score is calculated as follows:

Provider per 1,000 population ratio [28.7 points max]
Percent of population at 100% of the Federal Poverty Level (FPL) [25.1 points max]
Elderly ratio, percent of population age 65 and over [20.2 points max]
Infant Mortality Rate [26 points max]

Analysis of Bay Area Counties

San Francisco

Most of the county of San Francisco does not have a designated HPSA Scores. This means that most of San Francisco has low need for healthcare facilities. One exception is the Bayview District on the Eastern side of San Francisco which has a Primary Care HPSA score of 14. The Mission, Chinatown, and North Beach areas of San Francisco have a Mental Health HPSA score of 18. Overall, the county of San Francisco has an MUA/P score of 56.93. The areas designated medically underserved are shown in the map below.

We note here that all maps in this article are generated via a Map Tool created by the HRSA, see [2].

San Mateo County

Most of the county does not have a designated HPSA Score and is not medically underserved but the area that does have a score is East Palo Alto. East Palo Alto has a Primary Care HPSA score of 16. The MUA/P score for the East Palo Alto area of San Mateo is 58.8.

Looking deeper into San Mateo County we see that the only medically underserved population in the county is East Palo Alto. East Palo Alto has a very large Latinx population, 66.1% versus 24% in San Mateo County and has a poverty rate of 13.1% whereas San Mateo county has a poverty rate of 6.1%.

There is also a large population of undocumented immigrants in East Palo Alto as well as a big discrepancy between the $122,641 median income of San Mateo county and the $67,087 median income of East Palo Alto, [3] [4]. The areas surrounding East Palo Alto like Palo Alto and Menlo Park are known for being affluent and have greatly benefited from the tech industry, but East Palo Alto has not seen the same quality of education, housing or healthcare and due to the gentrification of the area the rent continuously increases and it is pushing many away from their East Palo Alto homes.

Below are the demographics of San Mateo County and of East Palo Alto specifically.

San Mateo County Demographics [US Census]

East Palo Alto Demographics [US Census]

Contra Costa County

The average HPSA score for Contra Costa County is 16.9. This score is found on the Data HRSA Gov website datasheet. This is the average of the 10 scores found in this area, with a highest score of 25 and the lowest score being 12.

Primary Care Average: 17

Dental Health Average: 23

Mental Health Average: 13.2

The average MUA/P score for Contra Costa County is 56.7. This score is found on the data sheet that was previously mentioned.

We include now a few statistics about Contra Costa County that give an idea of the financial position of those living in the county [5].

The median value of an owner occupied housing units between the years of 2015 and 2019 is $625,800.
The median selected monthly owner costs of with a mortgage is $2,745.
The median gross rent is $1,819.
There are roughly 7.9% of citizens living in poverty in Contra Costa County. This is considered a low poverty rate for a county.
The median household income is $99,716.
There are roughly 5.9% of citizens under the age of 65 who do not have health insurance.

Alameda County

Alameda County is composed of 18 cities. It is the 7th most populous county in California, and 20th in Country. Although it’s not the most well known county in the Bay Area it’s home to a robust community college system and great universities such as UC Berkeley, CSU East Bay, and Mills College. Alameda County is quite a diverse county. That diversity began during the height of WWII there was an influx of people moving here from other parts of the country to work in ship building etc.

One can observe in the maps to the right that Cal State East Bay is located near an area designated as medically underserved. Much of the area in Alameda county that is designated medically underserved, is home to many Cal State East Bay students. Cal State East Bay offers some health care services to it's students. To be eligible for SHCS (Student Health & Counseling Services) a person must be a Regularly or Non-regularly enrolled student. Although through SHCS students have access to primary care including prescription drugs, and labs, there are limits. Medi-Cal or Covered CA can help student extend their access to healthcare services.

A Comparison with Los Angeles County

The county of Los Angeles is the most populous county in the United States, with more than 10 million inhabitants in 2018. The county has 88 cities that represent a dynamic and multicultural economy that has a diverse workforce and top universities. Los Angeles County has some of the most iconic landmarks in the states.

The HPSA scores in Los Angeles County can be found on the map below. One can see how the diversity of Los Angeles translates to varying degrees of access to health services. We also include a map that indicates which areas of Los Angeles are designated medically underserved.

Again we provide some statistics that give an indication of the financial state of those living in Los Angeles County.

The median value of an owner occupied housing units between the years of 2015 and 2019 is $583,200.
The median selected monthly owner costs of with a mortgage is $2,489.
The median selected monthly owner costs without a mortgage is $608.
The median gross rent is $1,460.
There are roughly 13.4% of citizens living in poverty in Los Angeles County. This is a higher poverty rate than for example, Contra Costa County.
The median household income is $68,044.
There is roughly 6.1% of citizens under the age of 65 who do not have health insurance.

People living in different areas of California experience different living conditions. This includes differences in housing, incomes, poverty levels, medical expenses, number of healthcare providers, etc. To get a better understanding of medically underserved areas in California we will be comparing Contra Costa County, which is located in Northern California to Los Angeles California, which is in Southern California.

The difference between Contra Costa County average HPSA score 16.9 and Los Angeles County average HPSA score 17.1, is 0.2. This is not a large difference between the scores, meaning the components that go into these scores, such as the primary care, dental health and mental health, are very similar.

Los Angeles County is a much larger county, with a population of 10,039,107. Contra Costa only has a population of 1,049,025. Since LA county is much larger this is an important factor when comparing the two. The poverty level in Contra Costa county is lower than LA County by 5.5%. The cost of living in LA is also cheaper compared to Contra Costa. This is evident since the poverty level is higher, the price of living is also cheaper.

References

[1] Scoring Shortage Designations. Health Resources and Service Administration. (2021). https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation/scoring.

[2] Map Tool. Health Resources and Service Administration (2021). https://data.hrsa.gov/maps/map-tool/

[3] U.S. Census Bureau (2019). San Mateo County, California. https://www.census.gov/quickfacts/fact/table/sanmateocountycalifornia/PST045219

[4] U.S. Census Bureau (2019).East Palo Alto city, California; San Mateo County, California. https://www.census.gov/quickfacts/fact/table/eastpaloaltocitycalifornia,sanmateocountycalifornia/PST045219

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