On health-care issues in the District, Mayor Muriel E. Bowser (D) acknowledged during a news conference that “these are stubborn issues,” but said there have been marked improvements in the last decade. (Matt McClain/The Washington Post)

The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser.

Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered.

These are some of the issues addressed in the mayor’s 168-page plan for the District’s health-care systems. The plan, which since 1989 has been required by law to be completed every five years, is broad in scope and short on specific recommendations.

The regularly scheduled report, however, was presented at a time when the city’s only public hospital, United Medical Hospital, is struggling financially and its quality has been suffering. Last month, the facility, which also is the only full-service hospital east of the river, was forced to close its maternity unit due to a series of grave mistakes.

Health imbalances among District neighborhoods have been persistent and long-standing. Ten years ago, when then-Mayor Adrian Fenty released his plan, he listed eliminating racial and ethnic health disparities as a priority.

Bowser (D) acknowledged during a news conference that “these are stubborn issues” but said there have been marked improvements in the last decade.

The District’s ability to expand Medicaid coverage — the public insurance program for the needy and disabled — under the Affordable Care Act has meant that 97 percent of all residents have insurance, she said.

Since 2006, the city had committed to use its share of federal tobacco settlement funds to build community health centers in areas where residents have no easy access to primary-care doctors, promising at least one clinic each in Wards 7 and 8 — which are now in place.

A number of health issues, including asthma, depression, diabetes and heart disease, are highest in Ward 8, according to the report.

Former mayor and council member Vincent C. Gray (D-Ward 7), who is widely expected to challenge Bowser in the next mayoral primary, has been openly critical of her commitment to bringing better health care to Wards 7 and 8.

“What has been missing from the District’s health-care landscape is any leadership or vision by the current mayor suggesting she is an advocate for bringing health equity to the East End of the District,” Gray said. “The mayor’s recent budget failed to articulate a vision for how the city will address the health disparities abundantly evident in key areas of the city.”

Having high rates of insurance coverage and added medical facilities haven’t been enough on their own to enhance the quality of care in low-income areas.

Obstacles in transportation and to healthy shopping options are among the impediments that can still undermine good health, said Maria Gomez, president and chief executive of Mary’s Center.

Gomez agreed that health access has expanded in some neighborhoods where service was acutely lacking. But people in some of those same areas continue to face other daunting daily challenges, she noted.

“As long as people don’t have safe and permanent housing or don’t have enough food to eat and we don’t coordinate those services that are so crucial to health, we’re not going to continue to make the gains we’ve made,” Gomez said.

Last month, low-income District residents filed a federal lawsuit over what they contend are failures in a food-stamp program that at times left them without money for food.

The mayor’s overview of the District’s health system touched on these barriers, but did not delve into those specific problems.

It did not address the closure of the obstetrics wards at UMC and also at Providence Hospital in Northeast Washington, which has left women in those neighborhoods with few options for their maternal health care.

Earlier this month, the mayor announced that a replacement hospital will be built on the St. Elizabeths campus in Southeast Washington, but that plan is in the very early stages.

To keep UMC afloat until then, the mayor hired the consulting firm Veritas. A Washington Post analysis discovered that the founders of the firm, hired at $300,000 a month by the city, were contributors to the mayor's political campaign and that consultant fees have been rising under the no-bid contract to stanch financial losses at the medical center.

The mayor’s five-year report, which does not suggest any specific policy change, is intended as a guide to help the city make decisions about where to focus resources and to enhance programs including some already proposed on the health-care front, Bowser said.

In a city facing a glut of non­emergency 911 calls for health events, Bowser cited a proposed pilot program that would place nurses in 911 call centers to help triage calls so that fire equipment and ambulance crews are reserved for life-threatening issues and 911 callers without urgent health matters can be directed to a primary-care doctor or clinic. That pilot program, in which nurses would talk with callers to identify their issues, is expected to start in February 2018.

The city has said that it handles more than 200 calls a day from city residents who need medical care but are not experiencing life-threatening crises.