The colocation of primary care physicians and audiologists in the Chicago metro region reinforces racial, ethnic, and class inequities in spatial access to care

In primary-care-centric models of care provision, specialist co-location with primary care physicians (PCPs) can potentially improve care coordination and continuity. This study asks whether the co-location of specialists with referring PCPs can reinforce racial, ethnic, and class inequities in spatial access to care. Given a US healthcare policy context wherein audiologist services are only reimbursed if they are medical practitioner-referred, audiologists are hypothesized to co-locate with PCPs. Using spatial cluster analysis and spatial regression approaches, this study quantifies the tendency for PCPs and audiologists to co-locate and analyzes the consequences for spatial access disparities in the Chicago, Illinois metropolitan region. Audiologists and PCPs co-cluster significantly across Chicagoland. The spatial lag model confirms racial, ethnic, and class disparities in network travel distance to audiology services in the core counties of the region. The results suggest that, for audiology services, health policies and the resultant interdependence across the hierarchy of care manifest spatially, possibly reinforcing service access disparities within segregated city regions.