Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

In Preventive Medicine Reports, Krisda Chaiyachati and colleagues, including Jeffrey Hom and David Grande, describe the association between the quality of an individual’s built environment, as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access), with having a usual source of care among low-income adults in Philadelphia. They ascertained usual source of care (other than a hospital or emergency department) with the question: “Is there a particular doctor's office, clinic, health center, or other place that you usually go if you are sick or need advice about your health?”

The authors surveyed 1,000 new Medicaid enrollees between 2015 and 2016, 321 of who responded. For this analysis, the authors included 190 respondents who volunteered the use of their address. After adjusting for individual sociodemographic factors, self-rated health status, and area-level crime, the authors found that respondents living at an address with low Walk Scores (< 70) had 84% decreased odds of having a usual source of care compared to those living in high Walk Score areas (>85). Transit scores were not associated with having a usual source of care. This study suggests that the built environment, as measured through Walk Score, may affect health care access. The authors conclude that Walk Score may be a potentially useful tool for urban planners, public health officials, and health care leaders to identify populations at risk for worse primary care access.