Primary care access a key to health disparities among counties

Washington If you're a resident of Howard County, Md., chances are fairly high that you have insurance, enjoy good health and have relatively easy access to a primary care physician. Take a short car ride to Baltimore, however, and the situation for residents is much more grim.

In Howard County, ranked as Maryland's healthiest in the most recent County Health Rankings and Roadmaps survey, only 9% of residents are uninsured, and just 8% are considered in poor health. There's one primary care physician for every 577 patients. In Baltimore City, the unhealthiest county in the state, the uninsured rate is nearly twice as high, and there's only one primary care doctor for every 985 patients — a combination that means a significant access-to-care problem.

The comparison underscores a key finding in the 2013 survey: Gaps between the healthiest and unhealthiest counties in individual states are large and continue to grow. The survey highlighted the fact that residents in the healthiest counties are 1.4 times more likely to have access to a primary care physician than those in the least healthy counties. Unhealthy areas also had higher rates when it came to a host of other negative indicators of overall health, including child poverty, teen pregnancy and premature death.

This is the fourth year that the Robert Wood Johnson Foundation and the University of Wisconsin School of Medicine and Public Health have surveyed the health of every county in the U.S., ranking them on a state-by-state basis to gauge the factors determining the health of residents. All survey measures use figures or percentages that take population into account so that a county such as Howard, with a population of less than 300,000, can be compared with Baltimore City's population of more than 600,000.

The rankings are set up so that every state has a healthiest and unhealthiest county despite the overall health of the state. But health outcomes can vary widely within a state, said Patrick Remington, MD, MPH, professor and associate dean at the University of Wisconsin School of Medicine and Public Health, during a teleconference to discuss the 2013 rankings. Louisiana and Mississippi are two states that often rank last in the nation on overall health. But when researchers dig into each state, they find as much variability among individual counties in Louisiana and Mississippi as they do in Vermont, a state that ranks relatively high nationally on patient health outcomes, he said.