An occasional series about the barriers to health and health care for low-income urban Americans

Poor Health/A special report: How we did it

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An occasional series about the barriers to health and health care for low-income urban Americans.

Lillian Thomas of the Pittsburgh Post-Gazette examined the barriers to health and health care for low-income urban Americans through a nine-month Perry and Alicia O’Brien Fellowship in Public Service Journalism at Marquette University. Thomas worked with journalists from the Milwaukee Journal Sentinel and was supported by students from Marquette’s Diederich College of Communication. Future installments in this series will examine the effect of hospital closures and new models for improving health care.

Marquette Students Kara Chiuchiarelli, Sarah Hauer, Eric Oliver and Eva Sotomayor contributed to this project.


To examine the changing landscape of hospitals in large metropolitan areas, the Pittsburgh Post-Gazette and Milwaukee Journal Sentinel used Provider of Service files from the Centers for Medicare and Medicaid Services. The files, one dating from 1991 and another from 2013, provide snapshots in time of the locations and services offered by the hospitals that were registered with CMS at the time.

The analysis focused on short-term acute care centers -- that is, hospitals with emergency rooms -- in metro areas with at least 1 million population.

For measures of poverty, median income and disability, the newspapers used the five-year American Community Survey from the U.S. Census bureau. Zip code tabulation areas were assigned to each hospital based on physical location, then compared to the broader metro area.

The newspapers also examined primary care physician shortage areas using data from the U.S. Health Resources and Services Administration. Geographic areas, as well as populations of people, can be considered to be in a shortage area if there are fewer than 1 primary care physician per 3,500 people. In areas of greater need, that figure is 1 doctor to 3,000 people.

Kevin Crowe of the Milwaukee Journal Sentinel staff completed the data analysis.

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