NYC’s Hospital System Works In “Jim Crow-Style Racial Segregation,” Study Shows

It’s already semi-common knowledge that NYC’s school system is the most racially segregated in the country. But an uncomfortable new study published in the International Journal of Health Services shows that the city’s hospital network, too, exists in a old-fashioned era of “stark,” Jim Crow-style racial segregation — with a side of caste system, too.

…Columbia University (in Harlem), Cornell University and NYU are serving black and low-income residents at roughly half the rate as non-academic city hospitals.

The study, a joint project between the City University of New York (CUNY) and two universities in Boston, shows that city hospitals run by prestigious academic institutions such as Columbia University (in Harlem), Cornell University and NYU are serving black and low-income residents at roughly half the rate as non-academic city hospitals.

“Stark racial segregation persists to this day in New York’s hospitals,” said study co-author Dr. David Himmelstein, a CUNY professor and Harvard Medical School lecturer who has worked at both academic and non-academic hospitals in NYC.

“Our most prestigious institutions find ways to avoid black and poor patients,” Himmelstein said.

This, despite the fact that academic hospitals likewise receive “tax exemptions worth tens of millions of dollars” under the assumption they’ll provide “community benefits, including caring for Medicaid and uninsured patients,” the study says.

This, despite the fact that academic hospitals likewise receive “tax exemptions worth tens of millions of dollars” under the assumption they’ll provide “community benefits, including caring for Medicaid and uninsured patients,” the study says.

In Harlem here is the academic hospital reprimanded in the new study:

• New York-Presbyterian/Columbia University Medical Center (Columbia)

Here’s the remainder of the list of the city’s academic hospitals, or at least the ones reprimanded in the new study:

• Hospital for Special Surgery (Cornell University)
• Memorial Sloan-Kettering Hospital for Cancer (Cornell University)
• Montefiore Medical Center’s Weiler Hospital (Albert Einstein College of Medicine, Yeshiva University)
• Mount Sinai Medical Center (Icahn School of Medicine)
• Hospital for Joint Diseases (NYU)
• Langone Medical Center/Tisch Hospital (NYU)
• New York-Presbyterian/Weill Cornell Medical Center (Cornell)

The core problem with these elite hospitals serving so few black and low-income patients, researchers said, is that in general, they provide more “specialized expertise across a range of clinical services” — especially for complex and/or rare conditions, which minorities and poor people deal with too, of course — and are more likely to have the “latest technologies” available. So overall, their patients are more likely to receive top-of-the-line care.

Not to mention that many of the city’s public, non-academic hospitals are facing severe financial hardships and a lack of resources, while many of the academic hospitals “regularly generate multimillion-dollar surpluses,” the study says.

Boston’s hospitals, by comparison, are “much less segregated by race or health insurance status,” researchers found.

So how did NYC’s hospital system get so segregated?

There appear to be a number of factors. Among them, according to Dr. Himmelstein (“AMC” stands for academic medical center, FYI):

• Virtually all of the AMCs maintain separate, and inferior clinic systems for Medicaid patients. These clinics usually have longer waits for appointments than the practices that are available to privately insured patients, are generally staffed by residents, rather than attending physicians, patients must switch physicians often and have difficulty reaching a doctor by phone or at night. All of these features make it less likely that Medicaid patients will be hospitalized at the AMC.

• I’m not aware of any AMC in New York that makes outpatient services readily available to uninsured patients, effectively channeling them elsewhere. Moreover, uninsured patients who present to an AMC’s emergency room and subsequently need to be hospitalized may be transferred elsewhere.

• Several of the AMCs either don’t have any emergency room, or have a very small and out of the way emergency room. Since the emergency room is often the portal of entry for minority, uninsured and Medicaid patients (because they don’t have a personal doctor they can reach), this discourages inpatient admissions for these patients at AMCs.

• At the AMCs with larger ERs, these ERs are generally overcrowded, unpleasant and have long waits for care, again cutting down on the admission of uninsured, minority and Medicaid patients5- Several AMCs have been establishing practices distant from the hospital. But few of these are located in poor and minority neighborhoods, which have the greatest medical needs. In effect, the AMCs are reaching out to white and well insured communities.

• The paucity of minority physicians at most AMCs may make minority patients feel less welcome there.

Via source

Editor’s note: I think the National Football Leagues revenue sharing program is something the NYC’s Hospital System should look at since the problem of caring for all New Yorkers is about “money”. For example, as of 2015, NFL teams each received $226.4 million from the league as part of national revenue sharing from the 2014 fiscal year. The total surpassed $7.2 billion and comes mostly from the league’s television deals. This should be a topic for elected officials from Harlem to Hollis Queens.