Urban hospitals tend to respond to white patients, the analysis finds

Urban hospital markets are more likely to segregate patients based on race, a new analysis shows.

Hospitals in subway markets tend to serve a mix of whiter and richer patients, while others serve primarily patients of color and lower-income individuals, according to Lown Institute’s analysis of Medicare claims ranging from 2013 to 2018 in 3,200 hospitals. In the top 50 most inclusive hospitals, people of color were treated in 61% of patients on average, compared to 17% in the 50 lowest hospitals. Researchers classified hospitals by comparing how well the demographics of a hospital’s Medicare patients adapted to their surrounding communities.

More inclusive and less inclusive hospitals may be a few blocks from each other. The Metropolitan Hospital Center is East Harlem, NY, it’s about a mile away from one of the less inclusive hospitals, Lenox Hill, on the Upper East Side. The Metropolitan serves 77% of people of color while Lenox Hill serves 33%.

“It’s a form of segregation, to be clear,” said Dr. Vikas Saini, president of the Lown Institute, who describes several markets as the history of two hospitals. “In large cities where there was much more diversity, there was a real tendency for some hospitals to accommodate mainly richer, whiter and more educated patients. This left other hospitals to care for the poor, less educated and minority patients. “.

Hospital markets in Baltimore and Philadelphia were disproportionately less inclusive. Baltimore had nine of the most segregated hospitals and only two of the least segregated; Philadelphia had a ratio of 19 to 6.

Less inclusive hospitals served a population of patients who had an annual income of $ 29,000 above the market average. The most inclusive treated patients who earned nearly $ 27,000 less than the market average. Academic medical centers often treat patients at both ends of the spectrum.

There may be preferences of patients at stake that are difficult to count, said Terry Fulmer, president of the John A. Hartford Foundation, as patients choose parameters where doctors and nurses reflect diversity in their neighborhoods. .

“That said, it is not acceptable for health systems to work with populations selectively,” he said. “We can begin to close the gaps by insisting on new accountability measures that address inequity and relate to hospital quality and safety scorecards.”

Racial disparity has systemic roots. Discriminatory lending practices have segregated communities. Minorities were less likely to secure higher-paid jobs with health benefits.

Many hospitals have evolved to respond to certain types of patients and exclude others, Saini said. They are also looking for patients who can generate more revenue, he said.

“They tend to focus on paying customers and those who have business insurance, which tends to be white,” Saini said. “When they turn 65, they have already established what doctors see. When they see these results, it’s a good definition of structural racism as you can see.”

COVID-19 aggravated those iniquities. Transmission rates were higher based on the types of jobs people had and the homes in which they lived, among other social factors. Saini said hospitals that primarily serve these patients have been overwhelmed.

“It’s a threat to all of us,” he said. “Hospitals with a long history of color communities needed refrigerated trucks to keep the bodies of deceased patients, while the richer hospitals nearby had empty beds.”

Saini said hospitals will be tackling these social inequities where they open clinics, marketing campaigns, what kind of staff and doctors they take and financial aid guidelines. Providers must be recruited from the poorest, rural and minority communities. Leaders should involve community leaders and use inclusiveness metrics while structuring their operating models. Regulations should encourage a different mix of patients.

Then, hospitals will be required to meet these standards, experts said.

“You have to make some calls about how much income and high margins matter to you compared to the larger social mission,” Saini said. “As long as there are differences in the types of payments that hospitals expect to receive based on the type of insurance that patients have, it is difficult to solve the problem.”

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