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, we 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 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 that allowed users to view hospital openings and closures, physician shortage areas, disability rates and income by census tract. Part 2 of the Poor Health series focused on the frayed healthcare safety net in the Pittsburgh region. The five stories 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, the series found, include transportation challenges, 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, programs the Pittsburgh region has not employed. 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 focused on solutions to problems outlined in the first two parts of the series. The solutions looked at programs from around the country and in our focus cities of Milwaukee and Pittsburgh. Individual stories showed how a mobile, volunteer clinic in Indianapolis has met the needs of homeless there. A story out of a struggling steel town in suburban Pittsburgh showed how a free clinic opened there when a physician was told by his health system employer that he could not provide more care to the poor in his office. Another story out of Philadelphia showed how outreach workers helped patients navigate the health care system and with nonmedical issues, such as housing and transportation, with a goal of reducing readmission to hospitals. 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 under way.
