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Roadblocks to proper medical attention

The city recently released a health report focused on 11 neighborhoods whose residents face the most acute shortages of primary care access. One of the neighborhoods included in the study was Flatbush, specifically zip code 11226, an area roughly bounded by Parkside Avenue and Parkville Avenue to the north and south, Argyle Road to the west, and New York Avenue to the east.

The object of the report – put together by the New York City Health and Hospitals Corporation, along with a task force convened by City Council speaker Christine Quinn – was to determine how to improve the quality and access of primary care for people in these underserved neighborhoods.

“One of the most important and responsible ways we can improve healthcare is to provide access to quality preventive care, so that no one feels the emergency room is their only option,” said Quinn.

One of the report’s surveys looked at the barriers people said prevented them from seeing a doctor or a nurse in their neighborhood. The number one barrier in Flatbush, mentioned by 54 percent of respondents, was being forced to wait too in the waiting room.

At the same time, 32 percent of Flatbush respondents said their doctor or nurse did not spend enough time with them, while 29 percent reported their doctor or nurse did not listen carefully enough. Taken together, these statistics point to overcrowded and understaffed facilities in Flatbush.

The number two barrier to quality primary care was needing an appointment sooner than one was available, which was mentioned by 43 percent of respondents. Another barrier was simple inability to pay the bill, which 27 percent of Flatbush respondents reported as a problem.

Councilman Kendall Stewart, himself a podiatrist, think many of these problems stem difficulty many Flatbush residents have obtaining insurance. According to the survey, only 65 percent of Flatbush residents have health insurance, compared to 74 percent citywide.

Flatbush’s average income level, which is strongly correlated with the ability to have insurance, is also low. 59 percent of the area’s residents reported a household income of $20,000 or less.

“Most of the hospitals and clinics, unless they’re public, don’t tend to people with insurance,” Stewart said. “And at the public hospitals, they can make you wait for an entire day to be seen. “

The survey also asked respondents to list which type of doctors they had problems accessing in their neighborhood.

Dentists topped the list in Flatbush, with 54 respondents reporting difficulty obtaining dental care. Flatbush residents also said basic general practitioners (25 percent), mental health counselors (25 percent), family planning services (21 percent), and prenatal/obstetrician/gynecological care (11 percent) were difficult to access.

Stewart again pointed to lack of insurance coverage for his constituents as a reason why they have a hard time accessing certain types of doctors.

“Dentist, for instance, if you don’t have insurance, they don’t touch you. And a lot of times, these insurance policies don’t cover dental. They minimize the services they provide, so even if somebody says they have medical insurance, it’s really a only partial insurance,” he said.

According to Stewart, one of the major, yet correctable problems in his district is the lack of awareness among residents about insurance programs.

“People don’t know there are these policies like Health Plus and Metro Plus available for people with low-incomes, or undocumented people,” he said.

“The big problem is communication. What I want to do is to have more forums where we invite people to see what options are available to them. We have these things for housing and citizenship, so we should do more with health care.”

One of the obstacles to communication in Flatbush is the high number of residents – 53 percent – who speak a language other than English at home. Flatbush has both large Haitian and Hispanic populations.

“We need to make information about these programs available in other languages and promote it they way it should be promoted,” he said. “Until we do, we’re going to have the same problems.”

Stewart said he has had plenty of experiences in his own practice that underscoring the importance of preventative care.

“I have patients who come in with a problem with their foot, but it’s only when they come in for that that they find out that they’ve had diabetes for months or years. It’s only because of an emergency that they know. If they know beforehand and had preventive care, it wouldn’t have gotten to this point,” he said.

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