Part 1 of the “Poor Health” series used analysis of data from major U.S. metropolitan areas to show that people in poor neighborhoods are less healthy than their more affluent neighbors but more likely to live in areas with physician shortages and closed hospitals. Though research shows that poverty is correlated with poor health, the Post-Gazette and Journal Sentinel reporting by Lillian Thomas, Kevin Crowe and Guy Boulton showed that hospitals and doctors are following privately insured patients to more affluent areas rather than remaining anchored in communities with the greatest health care needs. The data analysis by Kevin Crowe showed that nearly two-thirds of the roughly 230 hospitals opened since 2000 were in wealthier, mostly suburban areas. The closures taking place were mostly of small to mid-size community hospitals in poor urban neighborhoods, as well as public hospitals. The findings were shown in interactive maps of the 52 metro areas, developed by Allan James Vestal of the Milwaukee Journal Sentinel, that allowed users to view hospital openings and closures, physician shortage areas, disability rates and income by census tract. Part 2 of the series focused on the frayed health care safety net in the Pittsburgh region. The stories, reported and written by Sean D. Hamill, began by pointing out that 11 of 39 hospitals in the region closed between 2000 and 2010 — and all but one of them were large providers of care to the poor. Further stories explored how that even with an increased number of free and federal health centers, the poor in the region often find that the care they need is unavailable to them. The reasons include transportation challenges or inability to get appointments with specialists, or because of high co-pays on insurance or upfront payments for those without insurance. The stories described efforts in other regions around the country to overcome these barriers through innovative programs that attempt to get the poor the care they need. Several stories illustrated efforts to make a difference for the poor — including volunteers at free clinics — but showed that holes remained in the safety net for patients in the face of inaction on the issue by the larger hospitals. Part 3 described some potential solutions to the problems raised in the first two parts of the series. It looked at programs and health systems that decided to focus on the poor, making them the centerpiece of efforts to spend less and give better care. Stories described a Philadelphia program in which outreach workers helped link patients with providers and worked to keep such patients healthy by helping with medication, diet, transportation, housing and other issues. The major reporting effort was on the work being done in Oregon, where an aggressive effort to lower costs and improve care for Medicaid patients is underway.
