Health

Community residents and their hospitals are feeling the effects of gentrification

“We shouldn’t assume these providers will do well because they now have a paying population,” said Dr. George Benjamin, executive director of the American Public Health Association. “The people living in these communities – if you don’t have rent stabilization – they will be forced to leave, and often their breadwinners are forced to leave.”

The changing healthcare landscape

Gentrification does not appear to have stopped or slowed down the financial problems facing many urban safety nets.

City welfare hospitals typically serve a large proportion of patients who are either Medicaid or not insured. Public hospitals have also traditionally accepted a smaller proportion of patients with higher paying commercial insurance compared to larger health care systems. Such factors often result in many social protection providers operating at low margins.

While such challenges have forced some city hospitals to close over the past decade and have jeopardized many others, many have opened up a range of outpatient care options, including emergency centers, specialist practices, outpatient surgery centers, and retail medical clinics. the same ennobled villages.

“If their paying patients with more reimbursable insurance plans leave them for these other organizations, either in another hospital or for these outpatient options, then they are losing patients who give them the margin,” Benjamin said. “In a sense, this could provoke a deterioration in the already volatile financial situation in this institution.”

In Brooklyn, New York, the increase in wealthy whites in some of its working-class neighborhoods over the past 20 years has coincided with a rapid decline in black and Hispanic populations in these communities.

The Williamsburg area in northern Brooklyn has been one of the fastest growing areas for many years. According to NYU’s Furman Center, the average rental price rose from $ 1,050 in 2006 to $ 2,060 in 2019. In contrast, average rents in Brooklyn as a whole rose from $ 1,150 to $ 1,510 over the same period.

“Gentrification creates unsafe housing in poor communities, which poses a huge challenge to providing good health care,” said Robert Hayes, president and CEO of Community Healthcare Network, a network of 13 federally qualified health centers in Brooklyn, Manhattan, Queens and Bronx.

While Hayes acknowledged that the gentrification that took place in Williamsburg had minimal impact on the number of patients at the CHN clinic in the area, he said the vast majority of these patients remain among the most vulnerable. About 65% of patients are covered by Medicaid and 10% by Medicare, with many of the rest uninsured. He said other providers who have opened community sites in recent years are primarily looking for Medicare-insured or privately-insured patients.

As a result, a niche patient market for CHN has been created, at least until more and more low- and middle-income residents are displaced.

“Commercial healthcare businesses don’t really want our patients,” Hayes said.

Although the number of patients remains largely unchanged, the influx of new outpatient sites into the area has intensified competition for health professionals. Hayes said higher demand for workers has made it difficult to recruit and retain clinical staff when other service providers can offer more competitive wages.

“We’ve always had to fight competition for doctors and other health care providers,” Hayes said. “Some of these groups that work with private equity pose a similar threat to our workforce.”

Problem solving

A decade ago, Humboldt Park Health, then known as a Norwegian-American hospital, was on the verge of closing its doors when the provider faced bankruptcy. Agrawal said it was then that the organization implemented a transformation plan that focused on improving quality metrics to build public confidence in the organization’s services.

This has led Humboldt Park Health to reduce infection rates and reduce unsafe practices among healthcare staff.

Agrawal felt that the organization could use the success of its quality improvements to attract more new residents to the community to access their services. In recent years, the organization has also sought to use its digital front door as a vehicle to attract more tech-savvy residents. Agrawal said the hospital’s self-scheduling feature on its website allows residents to make appointments more efficiently. She said patients find they can receive diagnostic services, such as an MRI, in a couple of days in the hospital, compared to waiting for weeks with other providers.

But one of the hospital’s main approaches to reaching more local patients was to partner with other health care providers in the community.

The hospital currently has partnerships with two local community health centers and often looks to new local doctors and clinics to find opportunities to work together, Agrawal said. This outreach led to Humboldt Park Health establishing informal relationships with several local doctors.

“This is for people who want to see it as a high quality option for caring for their patients,” Agrawal said of the partnership.

Community engagement is also a focus of the approach taken by the University of Houston College of Medicine, as service providers seek to help mitigate the early stages of gentrification in the City’s Third District.

Investments in the historic black community began about 10 years ago, but many of the gentrification-related changes have yet to be fully realized, said Dr. Brian Reed, head of the clinical sciences department at the medical school.


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