Few poor or minority patients in New York City’s academic hospitals

(Reuters Health) - Black patients are half as likely as white patients to get care at academic medical centers in New York City even after accounting for differences in health insurance, a recent study suggests.

Compared to privately insured patients, people with coverage through Medicaid, the government health program for the poor, are three times less likely to receive treatment at these elite New York hospitals, the study also found. Uninsured patients are five times less likely to get care at academic hospitals.

“Academic medical centers are generally better able to provide highly specialized care for patients with complex or rare illnesses,” said lead study author Roosa Sofia Tikkanen, a researcher at the University of Massachusetts Medical School in Worcester who completed the work while at City University of New York School of Public Health at Hunter College.

“Most experts believe unequal access to high-quality health care contributes to disparities in health outcomes,” Tikkanen added by email. “In New York City, life expectancy can differ by up to 10 years between two neighborhoods that are located just six subway stops apart.”

About 18 percent of patients at academic medical centers are black, compared with almost one-third at other hospitals in the city, the analysis of discharge data from 2009 and 2014 found.

At the same time, 22 percent of patients were insured by Medicaid at academic hospitals, compared with 42 percent at other hospitals in the city. And only 1 percent of academic hospital patients were uninsured, compared with 4 percent elsewhere.

While Medicaid and uninsured patients accounted for nearly half of all patients at non-academic hospitals in the city, they made up less than one-quarter of inpatients at academic medical centers. At one-third of academic hospitals, less than 10 percent of patients had Medicaid or were uninsured.

To see how race, ethnicity and payer status affect the likelihood of being treated at an academic medical center, researchers analyzed data on adults discharged from hospitals in New York City in 2009 and 2014, and they also looked at similar data for Boston hospitals in 2009.

In Boston, uninsured and Medicaid patients were just as likely to be treated at academic medical centers as at other hospitals. And racial and ethnic minorities were slightly overrepresented at academic hospitals.

It’s possible some of the differences between the two cities might be explained by the extensive public hospital network in New York, the authors note in the International Journal of Health Services.

All of the academic medical centers in Boston and New York are nonprofit hospitals, however, and enjoy tax exemptions worth tens of millions of dollars, the researchers point out. In exchange, they are expected to provide community benefits, including caring for Medicaid and uninsured patients.

One limitation of the study is that researchers didn’t account for patients’ diagnoses or severity of illnesses, which could influence which hospital they went to for care, the authors add. The analysis of two cities also might not reflect what happens in other communities.

The study also didn’t examine the role of residential segregation or neighborhood poverty on use of academic medical centers, noted Asal Mohamadi Johnson, a public health researcher at Stetson University in Florida who wasn’t involved in the study.

“The issue of equity and fairness is at stake here,” Johnson said by email. “Academic medical centers should be held to higher levels of ethical standards in providing care for low income and minority patients.”

When there are disparities in patients’ access to care, academic medical centers may not offer the best possible education to new doctors, Johnson added.

“Active participation of academic medical centers in caring for non-whites and the poor prepares a more qualified and culturally competent generation of physicians and health care providers who will have more familiarity with the unique circumstances and barriers confronting these patients,” Johnson said.

SOURCE: International Journal of Health Services, online February 2, 2017.