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Study Shows Minority Patients Underrepresented At City’s Elite Hospitals

According to a study released last Thursday in the International Journal of Health Services, black patients are under-represented at New York City’s academic medical centers.


The findings are consistent with other reports over the years that show the city’s academic medical centers take fewer Medicaid and uninsured patients than safety-net hospitals, and insurance is often a proxy for race.


In New York City, Medicaid patients were one-half as likely, and uninsured patients were one-quarter as likely, as privately insured patients to receive care at an academic medical center, according to the study.


But “insurance coverage did not fully account for the striking under-representation of black patients,” the study’s authors wrote.


This particular study, written by authors at CUNY, Boston Medical Center and Cambridge Health Alliance, compared New York City to Boston, another town with prestigious academic medical centers and argued that Boston does a better job at treating black patients at its elite institutions.


There are many reasons New York City doesn’t fare as well as Boston, including the fact that academic medical centers make up a larger percentage of the overall market in Boston. There are fewer places in Boston for any patient, including black patients, to seek care.


In New York City, academic medical centers make up less than one-third of the market, and are, for the most part, in Manhattan. That means the safety-net providers in Queens, East Harlem or Central Brooklyn, which are predominantly low-income, minority neighborhoods, tend to see a greater percentage of black patients.


Still, it does not entirely account for the disparities or alleviate the concern that black patients in New York City are less likely to receive care at academic medical centers, according to Steffie Woolhandler and David Himmelstein, two authors from CUNY.


“The existence of a public hospital system does not lessen concern about the pattern of segregations by race and income, especially in view of the fact that the public system is chronically under-funded and under-resourced,” they wrote in an email. “The argument that [Health + Hospitals] existence excuses the best resourced hospitals from providing care to poor and minority patients is similar to a ‘separate but equal’ view, when we know very well that the resources are unequal.”


The idea that New York City’s elite institutions favor the commercially insured, which leads to racial disparities, is not new.


In 2008, the New York Lawyers for the Public Interest filed a civil rights complaint with then-Attorney General Andrew Cuomo, alleging Mount Sinai Medical Center, New York-Presbyterian Hospital and Montefiore Medical Center, three academic medical centers, treated commercially insured patients better than those with Medicaid or no insurance. Cuomo declined to pursue the case.


Last year, the State Legislature unanimously approved a bill that would have created a new class of safety-net hospitals and forced the state to provide increased funding to those institutions, one way to address what many see as an imbalance. Cuomo vetoed the bill.

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