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A new study published in the Wisconsin Medical Journal describes a health care system in Milwaukee’s inner city that is sorely lacking in primary care offices – and getting worse. An effort is already underway in the city, one likely to attract new federal funding, to greatly expand community health centers to serve low-income residents. Will it be enough?

According to the study, of the approximately 234 physician’s offices in the city, only about 20 percent are located in areas designated by the federal government as medically underserved. Slightly more than half of the census tracts in the city are designated as underserved. The tracts lie almost exclusively within inner city neighborhoods on the city’s north and south sides.

The report was based on phone surveys of the offices conducted in 2005. Interviewers found that “although the majority of physicians accepted new patients, most providers were available only during standard business hours, were located outside the inner city and limited acceptance of patients who were on Medicaid or had no health insurance.”

The 46 offices found in the inner city were largely consigned to three areas – Wisconsin Avenue west of Downtown, Oklahoma Avenue on the south side and Capitol Drive on the north side. Offices specializing in internal medicine, obstetrics and gynecology or pediatrics were even less likely to be located in the inner city. The survey found just 6 pediatrics offices in the inner city.

An earlier study by the Milwaukee Health Care Partnership sounded a similar alarm. The Partnership, founded in 2007 with a goal of expanding access to primary care, includes Milwaukee’s three federally-funded community health centers – the 16th Street Health Clinic, the Westside Healthcare Association and Milwaukee Health Services – along with some of the metro area’s major private health care providers.

In 2008, the Partnership commissioned a study which found that 54 percent of people with no insurance or just Medicaid didn’t see a primary care doctor in 2007. Some of them went to emergency rooms instead. About 45 percent of all emergency room visits were for issues that could have been treated by a primary care doctor – and about half of those were made by people with no insurance or just Medicaid.

“People who are poor get blamed for inappropriately using emergency rooms,” says Mary Jo Baisch, an assistant professor of nursing at UW-Milwaukee and co-author of the report just published in the Medical Journal. “But in many cases, it’s just really hard to get health care.”

Community health centers expand

Joy Tapper, executive director of the Partnership, says the three community health centers hope to double their capacities. Nationally, federal health care reform is expected to greatly increase funding for such centers in the next five years, including $1.5 billion for new construction projects. The Westside Healthcare Association, which has two locations in the city, is considering acquiring a new building next to its existing clinic at 3522 W. Lisbon Ave.

Tapper says 16th Street and Milwaukee Health Services are still looking for new locations. The Partnership is drawing up a funding strategy, she says, which could include a mixture of private and public dollars. Milwaukee Health Care for the Homeless, which also receives federal funding, is a member of the partnership and is considering expanding its outpatient mental health services.

Private health care providers are already providing $1.7 million a year to the community health centers, and they run their own clinics for uninsured patients of their own, including the Aurora Walker’s Point Community Clinic, 611 W. National Ave.; the Columbia St. Mary’s St. Ben’s Clinic, 1027 N. 9^th St.; and the Wheaton Franciscan Angel of Hope clinic, 209 W. Orchard St.

The demand for free clinics in the city has grown dramatically in recent years. In 2008, they served about 16,000 patients, according to the study, a 23 percent increase over 2006.

Although the clinics are helping, Baisch says the dearth of health care providers in the inner city is still growing. “My concern is you’re seeing the private system move out of the county,” she says. “I think they’re vying for market share and moving out to where they have paying customers.”

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