Getting Granular: New CHI Model Estimates Access to Care at the Zip Code Level

Life’s hectic. One example: Seeing a doctor is sometimes easier said than done. Maybe you can’t find child care or are reluctant to ask the boss for time off. Perhaps the provider you want to see doesn’t take your insurance or isn’t accepting new patients. 

Regardless of the reasons, nearly one of five Coloradans report not getting needed care in the previous 12 months. And the extent of the problem can vary dramatically depending on where you live.

The Colorado Health Institute’s new interactive map illustrates the probability — at the ZIP code level —  of being unable to get a needed health care appointment. The user-friendly map illuminates geographic pattern. And a complementary spreadsheet makes it easy to see all of the data behind the probability model, which is based on this question from the 2015 Colorado Health Access Survey (CHAS): Was there a time in the past 12 months that you were unable to get an appointment at the doctor’s office or clinic as soon as you thought one was needed?

Neighborhoods and communities with high probabilities of not getting an appointment tend to be scattered across the state. People in the San Luis Valley, Weld County and Southeastern Colorado face some of the greatest challenges in seeing a doctor.

The issue is illustrated by ZIP code 81251 in Twin Lakes. Residents of this rural and mountainous community south of Leadville must drive an average of 19 miles to the closest primary care provider, and the majority of them (60.9 percent) speak Spanish at home. Our research shows that residents of ZIP codes with transportation challenges and lots of Spanish-speaking households are likely to have difficulty seeing a doctor.

On the other end of the spectrum, ZIP codes within the U.S. Air Force Academy and Fort Carson had some of the fewest problems seeing a doctor. One reason for this may be the presence of primary care clinics on the military bases.

Access to care data is one of the most valuable and sought-after measures of the CHAS. Our goal is to understand how many Coloradans face challenges accessing care, the geographic and demographic variation in health access, and the reasons why people aren’t getting needed care. 

In the 2015 CHAS, 18.7 percent of Coloradans — nearly one million residents — said there was a time in the previous year that they couldn’t get a needed appointment. That’s up from 15 percent in 2013.

We have previously reported the finding at a regional level. Residents of the San Luis Valley were the most likely to report a problem accessing care in 2015 (29 percent). In contrast, the central mountain region of Gilpin, Clear Creek, Park and Teller counties had the lowest reported rate at 11 percent.

The ZIP code probability model allows us to see how access to care varies at a much more detailed level. We believe this cutting-edge data analysis will better inform health care decision-making, from the planning process to implementation to evaluation.

Stay tuned for an update of this analysis in late 2017. The next iteration of the CHAS goes into the field this week. The new survey data will help Colorado policymakers and health care leaders understand the reach and impact of Obamacare several years after implementation. It will also set a baseline for any replacement efforts.

In the meantime, if access to care is top of mind for you, check out the CHAS access to care data workbook, which includes all access-related indicators since 2009. CHI’s Access to Care Index is another tool that paints a holistic picture of access to health care in Colorado. The Index is presented at the regional level and incorporates more than 30 measures that measure potential access, barriers to care and utilization. A new Medicaid-specific Index will be posted in the next few weeks.

Natalie Triedman is a policy analyst at CHI.